Obstructive and nonobstructive apneas elicit substantial increases in muscle sympathetic nerve activity and arterial pressure. The time course of change in these variables suggests a causal relationship; however, mechanical influences, such as release of negative intrathoracic pressure and reinflation of the lungs, are potential contributors to the arterial pressure rise. To test the hypothesis that apnea-induced pressor responses are neurally mediated, we measured arterial pressure (photoelectric plethysmography), muscle sympathetic nerve activity (peroneal microneurography), arterial O2 saturation (pulse oximeter), and end-tidal CO2 tension (gas analyzer) during sustained Mueller maneuvers, intermittent Mueller maneuvers, and simple breath holds in six healthy humans before, during, and after ganglionic blockade with trimethaphan (3-4 mg/min, titrated to produce complete disappearance of sympathetic bursts from the neurogram). Ganglionic blockade abolished the pressor responses to sustained and intermittent Mueller maneuvers (-4 +/- 1 vs. +15 +/- 3 and 0 +/- 2 vs. +15 +/- 5 mmHg) and breath holds (0 +/- 3 vs. +11 +/- 3, all P < 0.05). We conclude that the acute pressor response to obstructive and nonobstructive voluntary apnea is sympathetically mediated.

Importance The ongoing pandemic of the novel Corona Virus Disease 2019 (COVID-19) is an unprecedented challenge to global health, never experienced before. Objective This study aims to describe the clinical characteristics and outcomes of patients with COVID-19 admitted to Mercy Hospitals. Design and methods Retrospective, observational cohort study designed to include every COVID-19 subject aged 18 years or older admitted to Mercy Saint (St) Vincent, Mercy St Charles, and Mercy St Anne’s hospital in Toledo, Ohio from January 1, 2020 through June 15th, 2020. Primary Outcome Measure was mortality in the emergency department or as an in-patient. Results 470 subjects including 224 males and 246 females met the inclusion criteria for the study. Subjects with the following characteristics had higher odds (OR) of death: Older age [OR 8.3 (95% CI 1.1–63.1, p = 0.04)] for subjects age 70 or more compared to subjects age 18–29); Hypertension [OR 3.6 (95% CI 1.6–7.8, p = 0.001)]; Diabetes [OR 3.1 (95% CI 1.7–5.6, p<0.001)]; COPD [OR 3.4 (95% CI 1.8–6.3, p<0.001)] and CKD stage 2 or greater [OR 2.5 (95% CI 1.3–4.9, p = 0.006)]. Combining all age groups, subjects with hypertension had significantly greater odds of the following adverse outcomes: requiring hospital admission (OR 2.2, 95% CI 1.4–3.4, p<0.001); needing respiratory support in 24 hours (OR 2.5, 95% CI: 1.7–3.7, p<0.001); ICU admission (OR 2.7, 95% CI 1.7–4.4, p<0.001); and death (OR 3.6, 95% CI 1.6–7.8, p = 0.001). Hypertension was not associated with needing vent in 24 hours (p = 0.07). Conclusion Age and hypertension were associated with significant comorbidity and mortality in Covid-19 Positive patients. Furthermore, people who were older than 70, and had hypertension, diabetes, COPD, or CKD had higher odds of dying from the disease as compared to patients who hadn’t. Subjects with hypertension also had significantly greater odds of other adverse outcomes.

Amiodarone has several potentially fatal toxicities, the most important of which is amiodarone pulmonary toxicity (APT). We report a rare case where a patient developed acute interstitial pneumonitis 2 days after starting amiodarone. This report reveals the potential for rapid onset of APT and will help to increase awareness among health care professionals who very often underestimate the incidence of the toxic effects of amiodarone. A simple, cost effective screening tool to detect APT in its early stage is recommended.

Introduction: Nonspecific interstitial pneumonia (NSIP) is a type of idiopathic interstitial pneumonia that generally carries a favorable prognosis, however individual variability exists. These differences can possibly be linked to overlapping forms of interstitial pneumonia. Here, we present a case of Organizing pneumonia (OP) and NSIP overlap, which progressed to Acute Respiratory Distress Syndrome (ARDS) with eventual complete recovery of respiratory status. Case Presentation: 66-year-old male with history of Diabetes Mellitus, recent travel to Haiti one month prior was admitted with dyspnea, cough and weight loss (10 lbs). He was febrile (102.7°F). Physical exam showed fine crackles at lung bases and bilateral hand swelling without redness or tenderness. Chest X-ray showed right lower lobe infiltrate. HIV testing and Rheumatology workup were negative. Chest CT scan showed peripheral ground-glass opacities bilaterally in the lower lobes. Patient had septic shock and worsening hypoxemia progressing to ARDS (PaO2:FiO2 ratio of 91) requiring invasive positive pressure ventilation. Bronchoscopy was performed, with cultures positive for K. pneumonia and H. influenza, which were treated with antibiotics. Surgical lung biopsy showed NSIP and extensive nodular organizing pneumonia. He received a several-month course of systemic steroids resulting in improvement of his clinical condition, subsequent imaging, and pulmonary function tests. Eventually, he was tapered off steroids. Discussion: Overlapping forms of interstitial pneumonia have been reported, but are under-recognized and have histologic features that are not well-defined. It is crucial to identify these overlapping interstitial pneumonia, as they may vary in treatment and prognosis. NSIP/OP overlap, either idiopathic or autoimmune-associated was linked with unfavorable disease progression, and should, therefore, be recognized as a possible entity. In this case of NSIP/OP overlap, the patient developed ARDS requiring intubation, eventually followed by a tracheostomy. Over time, the patient had an improvement in his respiratory status and was able to be decannulated which highlights the overlap of NSIP and OP, leading to severe respiratory failure and ARDS followed by significant recovery. It emphasizes the need for a prompt diagnosis along with timely treatment and the potential for recovery that can be seen in such patients. Conclusion: Interstitial pneumonia can exist in overlapping forms and have variable disease progression. NSIP/OP overlap has been suggested to have an unfavorable disease progression, but further investigation is needed in order to better understand the pathogenesis, outcome and treatment options.