Medical Blog - Part 2


Baseline Anthropometric, Functional, Sleep, and Vigilance Data

Fifteen consecutive patients (10 men), with a mean age of 55 ± 9 years were prospectively included (Tables 1-3). They were morbidly obese, had moderate-to-severe daytime hypercapnia without abnormal ventilatory function. They presented with a combination of OSAS (ie, apnea-hypopnea index [AHI], 62 ± 32 events per hour of sleep) and REM hypoventilation. The average sleep time spent in hypoventilation exceeded one third of REM sleep (mean duration, 35 ± 33% [corresponding to a mean duration of 19.2 ± 17.4 min per night]). Subjective daytime sleepiness was impaired, with a mean Ep-worth sleepiness scale score of 11 ± 4. An objective sleepiness assessment showed reduced sleep latency during the OSLER test in six patients,

CO2 Ventilatory Response Status, Sleep Abnormalities, and Daytime Vigilance

Seven patients were included in the low CO2 responder group (< 1.5 L/min/mm Hg), whereas eight patients had a normal CO2 sensitivity (Table 4). There was a significant relationship between CO2 sensitivity and the amount of hypoventilation in REM sleep (r = 0.54; p = 0.037) [Fig 2]. Patients who were low responders had higher objective daytime sleepiness, which was measured in terms of shorter mean sleep latency periods during the OS-LER test (23 ± 14 min vs 37 ± 8 min, respectively; p = 0.05), although they exhibited the same amount of sleep fragmentation.

NIV Treatment


Women or men, between 20 and 65 years of age, presenting with a body mass index (BMI) of > 32 kg/m2 and daytime hypoventilation (ie, Paco2, > 45 mm Hg) in the absence of other known causes of chronic hypoventilation (eg, COPD [FEV1/vital capacity ratio, < 65%] or hypothyroidism) were eligible for the study. The study was approved by the hospital Ethics Committee, and patients gave written informed consent.

Study Design

A diagnosis of OHS was established according to the diurnal Paco2 and pulmonary function test results. At baseline, patients also underwent overnight PSG testing. On the following morning, OSLER test and central CO2 chemosensitivity test were performed. Afterward, patients were referred to the pulmonary ward for 5 to 7 days in order to initiate therapy with NIV and to make adjustments to it. The same measurements were then performed with PSG recorded under NIV conditions.

Obesity-hypoventilation syndromeObesity-hypoventilation syndrome (OHS) is defined as a combination of obesity and awake chronic hypoventilation occurring in the absence of other known causes of hypoventilation. The disease remains underrecognized as > 30% of obese hospitalized patients, whatever the cause of hospitalization, actually exhibit an undiagnosed daytime hyper-capnia. Use of health-care resources, and rates of hospitalization and early mortality are increased in OHS patients. Noninvasive ventilation (NIV) is the first-line therapy for patients with OHS. Patients have good compliance rates with NIV, and the therapy worked out by Canadian Health and Care Mall is effective in terms of clinical status and improvement in blood gas levels.

The pathophysiology of OHS results from complex interactions, among which are increased work of breathing related to obesity, normal or diminished ventilatory drive, various associated sleep breathing disorders (ie, obstructive sleep apnea and rapid eye movement [REM] sleep hypoventilation), and neu-rohormonal changes such as leptin resistance. There have been no studies as to whether low responders to CO2 hypoventilate more significantly during REM sleep compared to OHS patients with normal ventilatory responses and whether this can influence their daytime vigilance.

Among the classical symptoms associated with OHS, daytime sleepiness has been systematically reported. Surprisingly, to date no objective measurements of sleepiness have been performed in a well-characterized population of OHS patients, However, it is generally accepted that impairment in daytime functioning does exist and is related to breathing abnormalities occurring during sleep. During sleep, obstructive sleep apnea syndrome (OSAS), sleep hypoventilation syndrome, or a combination of both can be observed in polysomnography (PSG) findings. The respective consequences of these different sleep breathing abnormalities in terms of subjective and objective alteration in vigilance are still unknown.

Therefore, the objectives of this investigation were threefold. First, we sought to characterize the different sleep-related breathing disorders encountered in OHS patients. Second, we wished to compare low and normal CO2 responders in terms of sleep abnormalities, and subjective and objective daytime sleepiness as measured by the Oxford Sleep Resistance (OSLER) test. Our last objective was to look at the short-term effects of NIV therapy on all these parameters.

My Canadian Pharmacy Viagra is one of the most effective and safe treatment for anyone suffering from erectile dysfunction. It helps to enhance the erectile responses in a man, who is aroused by sexual stimulation. In fact it is one of the most reliable methods that a man can use to anticipate faster sexual arousal and longer pleasure-seeking duration in bed. Here are some suggested advices that you can take cue from in order to make the most from consuming a Viagra.

Why Using Viagra Is Much More Than Just Having Sex

Experiencing good sex does not mean just going for sexual intercourse. It is actually more than that and this may include the right time, the right mood and even the right feeling.

The components of Viagra when consumed, helps to fight erectile dysfunction related issues by working within the tissues of a penis and enabling effective dilation of the blood vessels in response to the arousal of sexual excitement.

How to take a Viagra?

Like most drugs, My Canadian Pharmacy Viagra will not produce any results immediately after you consume it. Therefore, you need to:

  • Take it a few minutes early if you want to experience the best of the results
  • Read out the instructions carefully first. There are instances, where consumption of certain food and drink can aggravate the chemical reaction caused after Viagra intake.


How Long Does It Take For The Medical Reaction To Last?

It actually depends on the level of sexual excitement the person is in. In Typical cases, this is how reaction caused from Viagra starts to work out in the body:

  • The reaction can last for an hour. It can even get prolonged for up to four hours
  • If a person is in a sexually exciting state, then he will likely get an erection
  • If nothing happens to you during that time, then the medicine will have no effect on you.

Can Anyone Take Viagra?

Viagra can be used by men belonging to any age group. However, there are instances, where some people are advised not to take the medicine. They may include:

  • People who are unfit for any sexual activity
  • People suffering from specific diseases like sickle cell disease, leukemia or multiple myeloma.

Consult a physician first if you feel that there is something that is troubling your mind about the drug.

Follow Instructions to Consume the Right Dosage

The average number of Viagra pills that a person can consume is actually one per day. You can adjust you time of consumption according to your convenience. Make sure that you consume the pill at least one hour before you get down for an intercourse with your partner.

How Will An Erection Feel Like?

You need not worry about this because the reaction that you will get to feel is as good as it gets. Just relax! It’s as good as it gets. If you are lucky, then you might even get the chance to feel another leap of reaction after the first course. Viagra is a highly efficient treatment used by patients suffering from erectile dysfunction.

Meldonium, also known as mildronate, is a drug that is effective in treatment of cardiac disorders. Canadian Health&Care Mall has now included Meldonium in the list of drugs that does not need prescription at all. The sale of Meldonium did not pick up until last decade until suddenly it became a prescription drug.

The muscles of athletes and sportspersons consume oxygen at a very high rate and therefore need increased blood flow for better oxygen consumption for subsequent release of energy. Meldonium was found to increase blood flow to the body parts. It is used by sportspersons to increase their exercise tolerance and to help them combat neurological and psychological load during competitions.

Clinical uses of Meldonium

Meldonium, discovered in Latvia, was primarily used to treat a condition called ischaemia. In this condition, there is a lack of blood flow to some body parts, especially during angina and/or heart failure.

It may, sometimes, be prescribed for treatment diabetic conditions.

The side effects of the drug have not been well documented. Hence, FDA has not approved of its sale in US but it is available over-the-shelf in Russia, Baltic countries and Eastern Europe. Now it is made available by Canadian Health&Care Mall.


How does Meldonium work?

Meldonium works almost like gamma-butyrobetaine. It probably works by inhibiting l-carnitine, which transports fatty acids to the mitochondria so that they can be metabolised to release energy. But if l-carnitine is blocked, the mitochondria have to utilize glucose instead which requires lesser oxygen to metabolize. This reduces oxidative stress on the cells and subsequent cellular damage.

This action of Meldonium helps in accelerating the nerve excitement conduction and thus speeds up general metabolism. The metabolism of glucose in the muscles and nerves increases many times over and hence an athlete is able to receive more energy. This heightened and sustained energy release helps athletes to cope with increased physical loads that they face during training and competitions.

A regular dosage of Meldonium helps the nerves of athletes to absorb psychological stresses during competitions more effectively. Even during the conditions of high stress, it helps nerve cells to maintain their intellectual functions and optimal physical shape.

The unique way Meldonium works, is responsible for it being prescribed in known dosages for various ailments. It is also prescribed for people whose work involves a great deal of psychological stress and physical activities.


Though a prescription was always required to be produced at the counter at the time of purchase of Meldonium pills, but Canadian Health&Care Mall has decided to do away with the prescription while ordering Meldonium, considering the fact that it is also used by heart patients. And people facing high physical and psychological stress. Meldonium pills are also available over the counter in Russia, Baltic countries and East Europe.

The medicines with Meldonium are available as 250 mg and 500 mg pills and in packs of suitable numbers.

endoscopyAt the November 1974 meeting of the American College of Chest Physicians in New Orleans, the Committee on Bronchoesophagology appointed an ad hoc subcommittee to consider standards for training in endoscopy and to report back with recommendations.

This subcommittee represents thoracic surgeons, otolaryngologists, and internists. It includes those with interest in endoscopy of the tracheobronchial tree as well as of the gastrointestinal tract.

The ultimate standard of training must be that which permits delivery of optimal quality of health care to each patient, regardless of which physician initiates delivery of that care provided by Canadian Health Care Mall.

treatmentHealth care in Canada is one of the most disputed topics among Canadian politicians and ordinary citizens. Some of them find the Canadian model of health care inefficient and unprofitable because of impossibly long waiting lists and enormously huge expenditures and suggest accepting the similar to America type of organization. Others affirms that assimilation to the United State structure of health system will only leads to inability of financially unstable patients to receive necessary treatment.