Decrease In Respiratory Rate Research Articles

Photosynthesis enhanced dark respiration in three marine phytoplankton species

The effects of previous photosynthetic activity on dark respiration rates were investigated in Heterocapsa rotundata (Dinophyceae), Rhodomonas salina (Cryptophyceae) and Thalassiosira weissflogii (Coscinodiscophyceae). Dark respiration rates were measured after 1 to 3h of light exposure in 12 bottles where incubation irradiances ranging from 0 to 600μmolphotonsm−2s−1. The results showed that the dark respiration increases with increasing light exposure (both irradiance and duration) in all exponentially growing cultures but not in two experiments with cultures in stationary phase (T. weissflogii). This relationship could be described by a linear model for all species, relating respiration to the previous accumulated photosynthetic product with a slope of about 0.035h−1, indicating a growth-related respiration of 3.5% per hour of the newly fixed carbon. The maximum respiration rate (Rmax) was estimated from both light dose and accumulated photosynthetic product using a non-linear model. Although Rmax and light-saturated gross photosynthesis (Pgmax) varied between the three species, a similar Rmax: Pgmax ratio of ~0.12 was found. The maintenance respiration rates which are comparable with maintenance respiration rates from literature, varied from 0.004 to 0.02molO2g−1Chlh−1 for the three species. Overall, this study suggests a diel periodicity of phytoplankton respiration driven by accumulation of newly fixed carbon in light. The consequence is a decreasing respiration rate during the night or during long dark incubations.

P6-1 - Protein Acetylation in Skeletal Muscle Impairs Mitochondrial Fatty Acid Oxidation and Limits Exercise Capacity in Post-Infarct Heart Failure in Mice

Background: Exercise intolerance is a major clinical manifestation in heart failure (HF) patients, due largely to skeletal muscle (SKM) abnormalities. Lysine Acetylation is a reversible post-translational modification involved in regulating mitochondrial metabolic enzymes. We investigated whether mitochondrial acetylation in SKM could contribute to impaired fatty acid oxidation and exercise intolerance associated with HF. Methods and Results: MI was created in male C57BL/6J mice by ligating the left coronary artery (n = 7), and a sham operation was performed in other mice (n = 7). After 4 weeks, the work and peak oxygen uptake (VO2) was significantly reduced in MI mice compared to sham mice (work 11 ± 1 vs 23 ± 1 J; peak VO2 143 ± 5 vs 159 ± 3 mL⋅kg−1⋅min−1). Mitochondrial proteins that include TCA cycle enzymes, electron transport chain, and fatty acid β-oxidation enzymes such as enoyl-CoA hydratase and 3-ketoacyl-CoA thiolase were hyperacetylated in SKM from MI mice, in conjunction with a decrease in mitochondrial fatty acid respiratory capacity rates. In addition, metabolomic analysis revealed that plasma N6-acetyl-lysine level was increased in HF patients compared to controls (15.0 ± 3.2 × 10−5 vs 9.8 ± 2.4 × 10−5, P < .01) and negatively correlated with peak VO2 measured by cardiopulmonary exercise test (r2 = 0.52, P < .01). Conclusions: Mitochondrial acetylation is associated with impaired fatty acid oxidation and reduced exercise capacity in HF. These results provide a novel pathophysiological insight into the mechanism of exercise intolerance in HF.

Effect of preharvest chitosan-g-salicylic acid treatment on postharvest table grape quality, shelf life, and resistance to Botrytis cinerea-induced spoilage

Sulfur dioxide fumigation used for many years to preserve quality and extend shelf life of table grapes is now under scrutiny for their adverse effects on food safety and the environment. Here, three new preharvest treatments, chitosan, chitosan plus salicylic acid, and chitosan-g-salicylic acid (CTS-g-SA), were evaluated for their effects on decay incidence, grape quality, and shelf life during cold storage. Of the three preharvest treatments tested, CTS-g-SA treatment exhibited enhanced activities of phenylalanine ammonia lyase, chitinase, and β-1, 3-glucanase, while also promoting accumulation of phenolic compounds and greater resistance to Botrytis cinerea decay. Moreover, CTS-g-SA application significantly decreased respiration rate, weight loss, and decay incidence, while improving levels of total soluble solids, titratable acidity, and sensory attributes of table grapes during storage. Coating fruits with CTS-g-SA has potential as a preharvest tool to enhance the quality and extend the postharvest shelf life of table grapes. This treatment is a highly effective and safer alternative to treatments currently in use.

Implication of the vagus nerve in breathing pattern during sequential swallowing in rats

The ventilatory pattern during sequential swallowing is influenced by the vagal activity. As the vagus nerve is paired and mixed, we aimed (1) to determine if vagal implication in swallowing and breathing coordination is symmetric. (2) to study the importance of vagal afferences in swallowing and breathing coordination. Sixty two Wistar rats (7–11weeks, 260–400g) were studied by barometric plethysmography. In the first part of the study, we determined the effects of a right cervical vagotomy and the effects of a left cervical vagotomy on ventilatory pattern at rest and during sequential swallowing (14 rats with right vagotomy, 14 rats with left vagotomy and 14 rats with sham surgery). Comparisons of ventilatory variables were made between right and left vagotomized animals. Thereafter, we determined the effects of electrical vagus nerve stimulation (VNS) on ventilatory pattern at rest and during sequential swallowing (10 rats with electrical VNS and 10 rats with sham VNS). We showed that a right or a left cervical vagotomy does not alter ventilation at rest, but induces during sequential swallowing a decrease in respiratory rate (RR) (p<0.001) and mean inspiratory flow (VT/TI) (p<0.01) compared to baseline. These modifications were not observed following sham surgery and there were no differences in ventilatory variables at rest and during sequential swallowing between right vagotomized rats and left vagotomized rats (p>0.05). Electrical VNS had no effect on ventilation at rest, but it minimized during sequential swallowing a decrease in RR related to a local alteration of the vagus nerve after placement of the electrodes as shown following sham VNS. In conclusion, the implication of vagus nerve in breathing pattern during sequential swallowing seems symmetric and influenced by activation of the vagal afferent pathway. These data can be useful when testing electrical VNS in swallowing disorders.

EFFECT OF OMEGA 3 AND REGULAR EXERCISE ON THE MUSCLE PERFORMANCE: SPECIAL PREVALENCE OF HISTAMINE AND NITRIC OXIDE PRODUCTION

Background: Skeletal muscle fatigue due to unaccustomed hard and/or prolonged physical exercise may be caused by increase of lactic acid, inflammatory mediators and oxidative stress. Stimulation of H1 receptors by histamine and the ensuing production of nitric oxide trigger the vasodilating effect of histamine on arterioles in exercise to supply O2 and nutrients and removal of CO2 and waste products. Objective: Investigating the effect of omega 3 alone or with regular exercise on improving muscle performance and delaying muscle fatigue. Subjects and methods: Forty apparently healthy subjects were studied. Depending on their previous physical conditioning status, subjects were divided into four equal groups: Two sedentary groups (group 1a without omega 3 therapy, and group 1b with omega 3), and two athletes groups (group 2a without omega 3 therapy, and group 2b with omega 3). Exercise tolerance was evaluated for each subject by using a free swimming competition (100 meters). Pulmonary ventilation, vital capacity, respiratory rate and heart rate were estimated before and after competition. Total antioxidant, lipid peroxides, total nitrate and nitrites, lactic acid and histamine levels were determined Results: Omega-treated and/or regular exercise volunteers showed significantly increase of pulmonary ventilation, vital capacity, total antioxidant, nitric oxide (NO) and histamine levels, and significantly decrease of qualifying time competition, respiratory, resting and maximal heart rates, plasma lipid peroxides, and lactic acid compared with corresponding values of volunteers without Omega 3 or regular exercise. The combination of omega 3 plus regular exercise was more effective than each one alone. Conclusions: The results obtained in the present study provided an evidence that daily administration of omega 3 and/or regular exercise improved muscle performance and delayed fatigue through release of histamine and NO during exercise.

Aroma oil therapy in palliative care: a pilot study with physiological parameters in conscious as well as unconscious patients.

The aim of this pilot study is to analyze the reactions of healthy test persons and conscious as well as unconscious palliative patients to aroma stimuli. In a randomized controlled study, healthy probands, conscious and unconscious palliative patients were exposed to two essential oils (lemon, lavender). Water was used as the control stimulus. Physiological parameters (breathing rate and heart rate, oxygen saturation, systolic, diastolic and mean arterial pressure) were measured. 10 test persons (control group), 15 conscious patients and 5 unconscious palliative patients were exposed to the stimuli. Healthy test persons reacted to lemon oil with a significant increase in respiration rate, heart rate and diastolic blood pressure, whereas to lavender oil with a significant decrease in respiration rate was measured. There were no significant reactions concerning the other parameters. Conscious and unconscious patients reacted with a significant increase in all measured parameters to lemon oil and with a significant decrease in all parameters except for oxygen saturation to lavender oil. No significant differences in the reactions were measured between the conscious and unconscious patients and no significant reactions to control stimuli were detected. All physiological reactions were very short and only detectable during stimulus presentation. Significant physiological reactions were measured after simulation with aroma oils in all three groups in this study. Healthy probands showed different reactions than palliative patients irrespective to their conscious state.

Nasal high flow oxygen therapy in the ward setting: A prospective observational study

BackgroundWhilst research demonstrates the benefits of nasal high flow oxygen in the intensive care setting, limited literature exists on its benefits in ward patients. ObjectivesThis study evaluated the use of nasal high flow oxygen in adult ward patients with respiratory failure or at risk of respiratory deterioration. Primary outcome was an improvement in pulmonary function as indicated by decreases in respiratory and heart rates and an increase in arterial oxygen saturation via pulse oximetry. Research methodologyUsing a prospective observational research design, purposeful sampling recruited 67 adult ward patients receiving nasal high flow oxygen between May and July 2015 (inclusive). All recruited patients were included in the data analysis. ResultsThe median age was 71.0 years (q25, q75=58.0, 78.0) and most patients were medical specialty patients (n=46, 68.7%). After commencing nasal high flow oxygen, respiratory rate (t=2.79, p=<0.01) and heart rate (t=2.23, p=0.03) decreased and arterial oxygen saturation via pulse oximetry increased (t=4.08, p=<0.001). ConclusionNasal high flow oxygen appears effective in a selective group of ward patients with respiratory failure, or at risk of respiratory deterioration, and may reduce demand on critical care beds; this warrants further research.

Relationship between oxygen concentration, respiration and filtration rate in blue mussel Mytilus edulis

The large water-pumping and particle-capturing gills of the filter-feeding blue mussel Mytilus edulis are oversized for respiratory purposes. Consequently, the oxygen uptake rate of the mussel has been suggested to be rather insensitive to decreasing oxygen concentrations in the ambient water, since the diffusion rate of oxygen from water flowing through the mussel determines oxygen uptake. We tested this hypothesis by measuring the oxygen uptake in mussels exposed to various oxygen concentrations. These concentrations were established via N2-bubbling of the water in a respiration chamber with mussels fed algal cells to stimulate fully opening of the valves. It was found that mussels exposed to oxygen concentrations decreasing from 9 to 2 mg O2/L resulted in a slow but significant reduction in the respiration rate, while the filtration rate remained high and constant. Thus, a decrease of oxygen concentration by 78% only resulted in a 25% decrease in respiration rate. However, at oxygen concentrations below 2 mg O2/L M. edulis responded by gradually closing its valves, resulting in a rapid decrease of filtration rate, concurrent with a rapid reduction of respiration rate. These observations indicated that M. edulis is no longer able to maintain its normal aerobic metabolism at oxygen concentration below 2 mg O2/L, and there seems to be an energy-saving mechanism in bivalve molluscs to strongly reduce their activity when exposed to low oxygen conditions.

Modeling the effect of oxygen pressure and temperature on respiration rate of ready-to-eat rocket leaves. A probabilistic study of the Michaelis-Menten model

Effective and efficient design of modified atmosphere packaging (MAP) systems for ready-to-eat (RTE) products requires knowledge on produce respiration rate under various temperatures and oxygen levels. In order to model the respiratory behavior of RTE rocket leaves under different storage conditions, leaves respiration rate was measured during storage under four initial oxygen partial pressures (2.5; 5; 10 and 20kPa O2) and three temperatures (0, 5 and 10°C), for 10 days. The respiratory quotient was determined and found to range between 0.6 and 1.3. Temperature showed a significant impact on respiration rate and the effect of oxygen partial pressures was found to be temperature-dependent. The oxygen pressure effect on respiration rate was accurately described using Michaelis–Menten kinetics, without inhibition by carbon dioxide, and the effect of temperature was well modeled by exponential functions. Monte Carlo simulation allowed quantification of the relative impact of the reduction of oxygen pressure and temperature on the decrease in respiration rate and the potential shelf life increase of RTE rocket leaves. Temperature contributed to more than 80% of the Michaelis–Menten model variance while oxygen pressure contributed only with 13%. The model obtained is a useful tool for defining packaging and storage conditions for a shelf-life extension of rocket leaves.

Spontaneous Breathing during Extracorporeal Membrane Oxygenation in Acute Respiratory Failure

We evaluate the clinical feasibility of spontaneous breathing on extracorporeal membrane oxygenation and the interactions between artificial and native lungs in patients bridged to lung transplant or with acute exacerbation of chronic obstructive pulmonary disease (COPD) or acute respiratory distress syndrome. The clinical course of a total of 48 patients was analyzed. Twenty-three of 48 patients were enrolled in the prospective study (nine bridged to lung transplant, six COPD, and eight acute respiratory distress syndrome). The response to the carbon dioxide removal was evaluated in terms of respiratory rate and esophageal pressure swings by increasing ("relief" threshold) and decreasing ("distress" threshold) the extracorporeal membrane oxygenation gas flow, starting from baseline condition. Considering all 48 patients, spontaneous breathing extracorporeal membrane oxygenation was performed in 100% bridge to lung transplant (9 of 9 extubated), 86% COPD (5 of 6 extubated), but 27% acute respiratory distress syndrome patients (6 of 8 extubated; P < 0.001) and was maintained for 92, 69, and 38% of the extracorporeal membrane oxygenation days (P = 0.021), respectively. In all the 23 patients enrolled in the study, gas flow increase (from 2.3 ± 2.2 to 9.2 ± 3.2 l/min) determined a decrease of both respiratory rate (from 29 ± 6 to 8 ± 9 breaths/min) and esophageal pressure swings (from 20 ± 9 to 4 ± 4 cm H2O; P < 0.001 for all). All COPD and bridge to lung transplant patients were responders (reached the relief threshold), while 50% of acute respiratory distress syndrome patients were nonresponders. Carbon dioxide removal through extracorporeal membrane oxygenation relieves work of breathing and permits extubation in many patients, mainly bridge to lung transplant and COPD. Only few patients with acute respiratory distress syndrome were able to perform the spontaneous breathing trial, and in about 50% of these, removal of large amount of patient's carbon dioxide production was not sufficient to prevent potentially harmful spontaneous respiratory effort.

Study of μ- and δ-Opioid Activities in Agents with Various κ-Receptor Selectivity.

A putative opioid agonist RU-1205 was ineffective within in vitro model of electrically induced contractions of rat ileum assessing the μ- and δ-opioid receptor pathways, while morphine inhibited these contractions in a dose-dependent and naloxone-reversible manners with EC50=2.6×10-7 M. In vivo experiments revealed no significant effects of RU-1205 on respiration and gastrointestinal tract contractile activity. In contrast, butorphanol decreased respiration rate by 25% (25-100 mg/kg) and slowed down the transit of labeled particles along the small intestine by 77.1% (1 mg/kg) and by 45.5% (10 mg/kg). Morphine-induced inhibition of peristalsis was dose-dependent with maximum effect (by 68.6%) observed in the dose of 10 mg/kg. It was concluded that the effects of RU-1205 are not related to activation μ- and δ-opioid receptors known to mediate the effects of non-selective opioid agonist morphine and agonist-antagonist butorphanol.

Respiratory adaptations to a combination of oxygen deprivation and extreme carbon dioxide concentration in nematodes

To examine physiological adaptations to the two combined stressors O2 deprivation and extreme CO2 concentrations, we compared respiratory responses of two nematode species occurring in natural CO2 springs. The minimum O2 concentration allowing maintenance of respiration in both species was 0.0176μmol O2ml−1 (corresponds to 1.4% O2 in air). After exposure to anoxia, individuals resumed respiration immediately when O2 was added, but on a lower level compared to control and without showing a respiratory overshoot. A species-specific response was found in respiration rate during 20% CO2: the more tolerant species maintained respiration rates, whereas the sensitive species showed a decreased respiration rate as low as after anoxia. The results indicate that during 20% CO2 the sensitive species undergo a survival state. We conclude, that the ability to maintain respiration even under low oxygen and high CO2 concentrations may allow the better adapted species to occupy an ecological niche in the field, where others cannot exist.

Influence of the prone position on a stretcher for pregnant women on maternal and fetal hemodynamic parameters and comfort in pregnancy

OBJECTIVES:To analyze the influence of lying in prone position on a specially designed stretcher on the maternal-fetal hemodynamic parameters and comfort of pregnant women.METHODS:A randomized, controlled trial with 33 pregnant women divided into 2 groups: pregnant group sequence 1 and pregnant group sequence 2. The order of positions used in sequence 1 was Fowler’s position, prone position, supine position, left lateral, Fowler’s position 2, supine position 2, prone position 2 and left lateral 2. The order of positions used in sequence 2 was Fowler’s position, prone position, left lateral, supine position, Fowler’s position 2, left lateral 2, prone position 2 and supine position 2. Each woman remained in each position for 6 minutes. For the statistical analyses, we used Wilcoxon’s test for 2 paired samples when comparing the prone position with the other positions. The variables are presented in graphs showing the means and 95% confidence intervals. Trial Registration: Clinical Trial No. ISRCTN41359519RESULTS:All the parameters were within the standards of normality. There were no differences between positions in terms of maternal heart rate, diastolic blood pressure, oxygen saturation and fetal heart rate. However, there were significant decreases in respiratory rate and systolic blood pressure in prone position 2 compared with left lateral 2. There was an increase in oxygen saturation in prone position compared with Fowler’s position and supine position 2 in both sequences. All the women reported feeling comfortable in the prone position.CONCLUSIONS:The prone position was considered safe and comfortable and could be advantageous for improving oxygen saturation and reducing the systolic blood pressure and respiratory rate.

Pharmacological properties of various anesthetic protocols in 10-day-old neonatal rats.

In general, the anesthesia in neonates involves high risk. Although hypothermic anesthesia is recommended in rats up to the age of 7 days, neonatal anesthesia for later periods has not been standardized. The present study investigated the pharmacological properties of conventional anesthetic protocols in 10-day-old SD rats. The rats were anesthetized with four anesthetics: a combination of ketamine and xylazine (K/X); a combination of medetomidine, midazolam, and butorphanol (M/M/B); isoflurane; and sevoflurane. Anesthetic depth was scored by reflex response to noxious stimuli. Induction and recovery times were recorded. Vital signs and mortality rate were evaluated for safety assessment. All rats died after administration of K/X at a dose of 60/6 mg/kg, whereas K/X at 40/4 mg/kg resulted in insufficient anesthetic depth, indicating inappropriate for neonatal anesthesia. Although M/M/B at the adult rat dose (0.15/2/2.5 mg/kg) did not provide surgical anesthetic depth, the mouse dose (0.3/4/5 mg/kg) showed sufficient anesthetic depth with relatively stable vital signs. Isoflurane required a long induction period, and caused remarkable respiratory depression and hypothermia, resulted in a 25% mortality rate. In contrast, sevoflurane provided consistent surgical anesthetic depth with rapid induction. Although respiratory rate decrease was markedly observed, all rats survived. Among the anesthetic protocols investigated in the present study, sevoflurane and M/M/B at the mouse dose were recommended for the neonatal anesthesia. Compared with adult rats, the required dose of both anesthetics in neonates was higher, possibly associated with their lower anesthetic sensitivity.

To Study the Effect of Post-Operative Physiotherapy Management in PostCABG Patients

Backround: Coronary Artery Bypass Graft (CABG) surgery is a form of heart surgery that redirects blood around clogged arteries to increase blood flow and oxygen to the heart. During CABG surgery, the surgeon uses a portion of a healthy vessel (either an artery or vein) from the leg, chest, or arm to create a bypass around the clogged artery. Patients typically receive 1 to 5 bypasses per operation depending on how many coronary arteries (and their main branches) are blocked. During CABG surgery with cardiopulmonary bypass a heart-lung machine artificially maintains blood circulation and oxygenation while the surgeon operates on the heart. Aims and Objectives: To increase cardiac efficiency, increase exercise tolerance or endurance and to get the effective and better post-operative results. Further at the end of the study we should be able to plan out an effective treatment plan for post-operative CABG patients and know the effect of Master 2-minute step test and 6- minute walk test in post–operative CABG patients. Methodology: Study was conducted in Hero DMC heart institute in Punjab. Sixty-seven study participants (aged between 40 years to 70 years) were randomly recruited to the study. Recruited study participants received treatment in two sessions that is master 2-minute step test procedure was used in morning and 6-minute walk test procedure was used in evening session. Assessment and reassessment was done before and after completion of treatment procedure on every day and data was collected using assessment format for 3rd and 7th day. Outcome measures: Primary outcome in both master 2- min step test and 6-min walk test showed that there occurs decrease in heart rate, respiratory rate, increase in oxygen saturation and decrease in exertion. Secondary outcomes included more decrease in heart rate, respiratory rate and fatigue and increase in oxygen saturation. Improvement in faster heart function elaborated from the Heart rate (p<0.05) with both procedures that is master 2-minute step test and 6- minute walk test. Conclusion: The result obtained after statistical analysis shows that both master 2-minute step test and 6-minute walk test has the additional advantage of faster recovery as analyzed from mean of the before and after exercise using Tukey’s method on both of 3rd day and 7th day.

Modulatory Effect of Ascorbic Acid on Propofol-Induced Anaesthesia in Goats

Ascorbic acid modulates the central nervous system either physiologically or pharmacologically, and has been proposed to function as a neuromodulator. The effect of ascorbic acid (AA, vitamin C) on some physiological parameters, onset and duration of anaesthesia following propofol anaesthesia was evaluated in goats. A total of 24 goats divided into four groups, comprising five goats each in groups I and II, and seven goats each in groups III and IV were used for the experiment. Groups I and II served as control for AA (200 mg/kg) and propofol (5 mg/kg) intravenous treatments, respectively; while groups III and IV received AA at 200 mg/kg and 300 mg/kg, respectively before propofol anaesthesia. The result showed that AA significantly (P < 0.05) decreased the onset of anaesthesia and increased the duration of propofol anaesthesia in goats. AA (300 mg/kg) induced a decrease (P < 0.05) in respiratory rate during anaesthesia, but there were no significant changes in heart rate and rectal temperature in the groups. In conclusion, AA potentiated the effect of propofol – induced anaesthesia in goats without alteration in heart rate and rectal temperature.

Guar Gum as an Edible Coating for Enhancing Shelf-Life and Improving Postharvest Quality of Roma Tomato (Solanum lycopersicum L.)

There exists an increasing interest from consumers and scientific community in developing edible-natural-biodegradable coatings to replace commercial wax-based coatings for maintaining postharvest quality of vegetables. In this work, the effectiveness of guar gum coating on various quality characteristics of Roma tomato at 22±2°C over a 20 d storage period was investigated. Tomatoes were covered with a 1.5% guar gum coating plasticized with glycerol at 30% and stored at 22±2°C and 40% RH for 20-d. Tomatoes covered with edible coating significantly enhanced firmness and reduced weight loss, delayed changes on soluble-solids-content, retarded loss of total acidity, and decreased respiration rate compared with uncoated-control fruit. Sensory analysis by trained panelists revealed that the use of the edible coating influenced the acceptability of tomatoes. There were significant differences on the scores given by panelists when comparing the coated and uncoated tomatoes. It was concluded that guar gum affected favorably the physicochemical, microbial, and sensorial quality properties of Roma tomato and therefore could be beneficial in delaying the ripening process at 22±2°C.

DOES ACUTE TRAMADOL TOXICITY INDUCE HYPOGLYCEMIA AND ACUTE PANCREATITIS? A CLINICAL STUDY OF ACUTE TRAMADOL POISONED PATIENTS

Tramadol is a centrally acting synthetic analgesic. Recently, tramadol overdose has become one of the most common causes of acute poisoning in Egypt and worldwide. Common symptoms of toxicity include respiratory depression and seizure. Hypoglycemia is another potentially fatal hazard that is newly emerging in association with tramadol. Therefore, the aim of this study is to investigate the effect of tramadol poisoning on blood glucose level and whether or not this effect is associated with tramadol-induced acute pancreatitis. Methods: A prospective study was conducted on patients admitted to the Poison Control Center, Ain Shams University hospitals from November 2014 to August 2016 with acute tramadol poisoning. All the patients were subjected to complete medical history, physical examination and routine biochemical laboratory tests. In addition to, measurement of serum levels of amylase, lipase and insulin. Blood glucose level was obtained twice; on admission and on the second day. Results: twenty nine patients, 25 males (86.2%) and 4 females (13.79%) met inclusion criteria. Mean age was (31.34 ± 8.75 years). There was significant decrease of blood pressure and respiratory rate in the tramadol poisoned patients (case group) as compared with the control group. The most frequent manifestations were; nausea and vomiting (93.1%), abdominal pain (86.2%), coma II (55.17%), miosis (37.93%) and sweating (34.48%). There was significant decrease of pH, PO2 and HCO3 and a significant increase of PCO2 in tramadol intoxicated patients. The case group showed significant decrease of glucose level on the second day as compared to the control group, as well as, when compared with glucose level on admission day. There was a significant increase of serum amylase level and a non-significant change of serum lipase and insulin levels among the case group in comparison with the control group. Conclusion: Fluctuations in blood glucose level particularly hypoglycemia can be considered a risk of tramadol poisoning. Acute tramadol toxicity seems unlikely to cause acute pancreatitis, despite the high amylase level. This debate still requires further studies. Clinicians should remain alert for serial blood glucose monitoring in tramadol poisoning.

Diaphragm electromyographic activity following unilateral midcervical contusion injury in rats.

The present study shows that unilateral contusion injury at C4 results in substantial loss of phrenic motoneurons but increased diaphragm muscle activity across a range of ventilatory and higher force, nonventilatory behaviors. Measures of neural drive indicate increased descending input to phrenic motoneurons that was more pronounced during higher force, nonventilatory behaviors. These findings reveal novel, complex adaptations in neuromotor control following injury, suggestive of increased recruitment of more fatigable, high-threshold motor units.

Prehospital treatment with continuous positive airway pressure in patients with acute respiratory failure: a regional observational study.

BackgroundPatients with acute respiratory failure are at risk of deterioration during prehospital transport. Ventilatory support with continuous positive airway pressure (CPAP) can be initiated in the prehospital setting. The objective of the study is to evaluate adherence to treatment and effectiveness of CPAP as an addition to standard care.MethodsIn North Denmark Region, patients with acute respiratory failure, whom paramedics assessed as suffering from acute cardiopulmonary oedema, acute exacerbation of chronic obstructive pulmonary disease or asthma were treated with CPAP using 100 % O2 from 1 March 2014 to 3 May 2015. Adherence to treatment was evaluated by number of adverse events and discontinuation of treatment. Intensive care admissions and mortality were reported in this cohort. Effectiveness was evaluated by changes in peripheral oxygen saturation (SpO2) and respiratory rate during transport and compared to a historical control (non-CPAP) group treated with standard care only. Values were compared by hypothesis testing and linear modelling of SpO2 on arrival at scene and ΔSpO2 stratified according to treatment group.ResultsIn fourteen months, 171 patients were treated with CPAP (mean treatment time 35 ± 18 min). Adverse events were reported in 15 patients (9 %), hereof six discontinued CPAP due to hypotension, nausea or worsening dyspnoea. One serious adverse event was reported, a suspected pneumothorax treated adequately by an anaesthesiologist called from a mobile emergency care unit. Among CPAP patients, 45 (27 %) were admitted to an intensive care unit and 24 (14 %) died before hospital discharge. The non-CPAP group consisted of 739 patients. From arrival at scene to arrival at hospital, CPAP patients had a larger increase in SpO2 than non-CPAP patients (87 to 96 % versus 92 to 96 %, p < 0.01) and a larger decrease in respiratory rate (32 to 25 versus 28 to 24 breaths/min, p < 0.01). In a linear model, CPAP was superior to non-CPAP in patients with initial SpO2 ≤90 % (p < 0.05). One CPAP patient (0.6 %) and eight non-CPAP patients (1.1 %) were intubated in the prehospital setting.DiscussionThe study design reflects the daily prehospital working environment including long transport timesand paramedics educated in treating symptoms of acute respiratory failure, rather than treating one specific diagnosis. The study population was included consecutively and few patients were lost to follow-up. However, the study was too small to allow assessment of any effect of prehospital CPAP on mortality, nor could the effectiveness in specific disease conditions be examined.ConclusionsIn an emergency medical service including physician backup, adherence to CPAP treatment administered by paramedics was high and treatment was effective in patients with acute respiratory failure.