In this article we review recent advances made in the pathophysiology, diagnosis, and treatment of inhalation injury. Historically, the diagnosis of inhalation injury has relied on nonspecific clinical exam findings and bronchoscopic evidence. The development of a grading system and the use of modalities such as chest computed tomography may allow for a more nuanced evaluation of inhalation injury and enhanced ability to prognosticate. Supportive respiratory care remains essential in managing inhalation injury. Adjuncts still lacking definitive evidence of efficacy include bronchodilators, mucolytic agents, inhaled anticoagulants, nonconventional ventilator modes, prone positioning, and extracorporeal membrane oxygenation. Recent research focusing on molecular mechanisms involved in inhalation injury has increased the number of potential therapies.

Background: Fatigue is a complex and disabling symptom of Multiple Sclerosis (MS); however, there is conflicting evidence of the relationship between fatigue and clinical features of MS. Furthermore, few studies have considered these relationships specifically in a progressive MS population. Aims:(1) estimate the prevalence of self-reported fatigue in people with MS; (2) evaluate the relationship between fatigue severity/impact and clinical features of MS; (3) compare the prevalence of fatigue, and the strength of relationship between fatigue severity/impact and clinical features of MS in progressive and non-progressive forms of MS.Methods: An online survey was conducted to measure the severity (Fatigue Severity Scale (FSS)) and impact of self-reported fatigue (Modified Fatigue Impact Scale) in people with MS. The survey also contained questionnaires related to disability, quality of life, MS impact, anxiety and depression, cognition, and sleep quality.Results: 412 people responded to the survey, of which 68.7% reported having fatigue (FSS≥5). The prevalence of fatigue was significantly higher in participants with progressive MS (81%) in comparison to those with non-progressive forms of MS (64%, p=0.01). Fatigue severity and impact were associated with quality of life, MS impact, anxiety, depression, cognition, and sleep quality in both progressive and non-progressive MS populations (p<0.05). However, fatigue severity (r = 0.335) and impact (r = 0.391) were correlated with disability only in participants with non-progressive MS. Conclusion:Fatigue was more prevalent amongst participants with progressive MS. In addition, higher fatigue severity and impact were associated with greater physical, cognitive, and psychological impairment, although the strength of association between these outcomes was generally similar regardless of the type of MS.

Background: Fatigue is a common and debilitating symptom of Multiple Sclerosis (MS); however, it is unknown what constitutes a clinically significant change in fatigue. Establishing the minimally important difference (MID) of fatigue outcome measures can inform the interpretation of changes in fatigue by estimating the level of change that is considered clinically relevant. Aim: Determine the MID for the Fatigue Severity Scale (FSS) and Modified Fatigue Impact Scale (MFIS) in people with MS. Methods: This cross-sectional study collected information on self-reported fatigue (FSS and MFIS) and quality of life (EQ-5D and MS Impact Scale 29) through an online survey. Anchor-based methods were used to estimate MID, and ordinal logistic regression models were used to determine the difference in fatigue that would predict a significant effect on quality of life. Results: 365 people with MS (81.9% female, 69.3% relapsing-remitting MS, mean age 46.2±11.6 years, mean time since diagnosis 9.6±8.7 years) responded to the survey. MID estimates for the FSS and MFIS ranged from 0.45-0.88 and 3.86-8.11 respectively, accounting for 6.4-12.6% of maximum FSS score and 4.6-9.7% of maximum MFIS score. Conclusions: MID estimates derived from this study indicate that a difference of at least 0.45 points on the FSS or 4 points on the MFIS constitutes a clinically significant difference in fatigue. Therefore, these estimates represent a threshold value which can be used to interpret changes in the FSS and MFIS over time or in response to an intervention.

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Patients with the chronic fatigue syndrome (CFS) complain consistently of delay in recovery of peripheral muscle function after exercise. The purpose of this study was to try to confirm this observation. A fatiguing exercise test was carried out on the quadriceps muscle group of ten patients and ten control subjects. The test consisted of 18 maximum voluntary contractions (MVCs) with a 50% duty cycle (10 s contraction, 10 s rest), and the force generated by each contraction was recorded using a KinCom dynamometer. This was followed by a recovery phase lasting 200 min in which quadriceps strength was evaluated at increasing intervals, and a follow-up session at 24 h post-exercise involving three 10 s MVCs. Throughout the exercise period, the MVCs obtained from the control group were significantly higher than those of the patient group (P = 0.006), but both groups showed a parallel decline in force over the 18 contractions, in keeping with a similar endurance capacity. Recovery was prolonged in the patient group, however, with a significant difference compared to initial MVCs being evident during the recovery phase after exercise (P = 0.001) and also at 24 h (P < 0.001). In contrast, the control group achieved MVCs which were not significantly different from initial values during the recovery phase, and maintained these at 24 h. These findings support the clinical complaint of delayed recovery after exercise in patients with CFS.