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“A constant, pounding noise disturbed Mr. Pickwick’s apartment. As soon as the door was opened, the figure of an exceptionally fat boy was seen standing with his eyes closed, as if asleep due to his calm and serene expression. When he asked him why he had come, he said nothing, but nodded once and seemed to be snoring lightly; Repeating the question three times produced no answer. As he was about to close the door, he opened his eyes abruptly, blinked several times, and raised his hand to knock again.”

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This brilliant staging by the writer Charles Dickens in Chapter 54 of his work The Posthumous Papers of the Pickwick Club went down in medical history as the first description of obstructive sleep apnea (OSA). Fat Joe, the chubby, pink, sleepy, slow-thinking (bradypsychic in medical terminology) fellow is great and summarizes the main clinical findings of this common disease.

Widespread but underdiagnosed: Although it is estimated to affect between 5% and 8% of the population, there are many cases that go unreported. And those affected can have serious consequences because other conditions (comorbidities) such as diabetes and cardiovascular diseases are associated with it.

And how can we know if we have OSA? We need to look out for these signs: heavy and irregular snoring alternating with pauses in breathing (apneas) due to airway collapse; sleep that is not restorative and is usually interrupted by multiple awakenings; excessive sleepiness during the day; slow to formulate thoughts and ideas as happened to Fat Joe; difficulty concentrating and memory; Headache, suffered chiefly in the morning; and nocturia, which is the need to get up several times during the night to urinate.

OSA and Obesity: The Chicken or the Egg?

Several epidemiological studies suggest a link between sleep disorders (including lack of rest) and obesity, which is one of the epidemics of the 21st century. Logically, OSA is the most common type of obesity related to sleep disorders.

But the relationship seems two-way. On the one hand, obese patients, particularly those suffering from so-called central-type obesity (with a pear-shaped or piriformis morphotype, such as Fat Joe), have OSA in a percentage exceeding 50%; On the other hand, 60-70% of people with OSA have this obesity problem, and those with insomnia are more likely to develop it.

This appears to be related to the hormonal and metabolic imbalance that causes sleep apnea. Because of these pauses in breathing, the production of leptin (hormone that creates satiety and increases thermogenesis, or heat production) decreases and that of ghrelin increases, which stimulates appetite and the formation of adipocytes, fat cells.

That is, under these circumstances, the brain establishes a procedure for saving energy, probably in the wrong way. In addition, there is an increase in the intake of foods rich in fat and sugar and a decrease in physical activity.

And as if that weren’t enough, the metabolism of patients with OSA can develop resistance to the effects of insulin, leading in many cases to diabetes mellitus.

vascular diseases

Another consequence of sleep apnea is the intermittent drop in blood oxygen levels caused by obstructive events. This leads to brain activation with micro-excitations in the brain, which we were able to observe in our studies in the sleep laboratory.

We somnologists interpret that these microexcitations, in which the individual does not become fully awake, represent a defense mechanism of the sleeping brain against an attack. Produced by the release of catecholamines (adrenaline), they increase the long-term risk of developing arterial hypertension, angina pectoris, myocardial infarction, stroke, sudden cardiac death…

It should be clear that early detection of OSA and effective treatment is a powerful weapon in preventing cardiovascular and cerebrovascular accidents. A simple nightly test at the patient’s home, such as a respiratory polygraph, can confirm or rule out the diagnosis.

Daytime sleepiness: risk of accidents

The poor quality of night’s sleep in patients with apnea has another fundamental connotation. Fragmented, superficial sleep with multiple micro-awakenings and brief awakenings – to which nocturia must be added – means that this sleep is not restorative, with consequent excessive daytime sleepiness.

The result is a low intellectual capacity with concentration, memory and problem-solving disorders, etc. And if these sleep attacks attack us while driving, there is a serious risk of suffering a traffic accident.

In fact, the Directorate-General for Traffic links daytime sleepiness to up to 30% of accidents. These are also usually the most serious, as they occur at high speed, without prior braking and in a frontal collision. Suffering from sleep apnea increases the risk of having a traffic accident by 3 to 7 times, an estimate that increases to 11 times when alcohol is also consumed.

OSA is also expected to increase the risk of accidents at home and at work. In the latter case, it increases by at least 50%, meaning that diagnosing and treating obstructive sleep apnea would prevent between 18,000 and 25,000 work-related accidents per year.

A mechanical device to remove the obstacle

And how can it be treated? The main technique against moderate or severe disease is based on the use of a night-time ventilation system with a compressor and a mask attached to it, blowing in purified air (CPAP-BIPAP machines). This puts positive pressure on the airway and allows the obstruction to be relieved during sleep. Some selected cases can also be resolved through surgery.

However, it should be noted that the best treatment for OSA is weight loss, adopting a healthy lifestyle, and following basic sleep hygiene rules.

Juan Jose Ortega Albas He is a specialist in clinical neurophysiology. Head of the Sleep Department of the General University Hospital of Castellón. Pisabius

This article was originally published on The Conversation. You can read the original here.

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Unusual! A Texas border patrol seized more than $400,000 worth of liquid methamphetamine in Halloween decorations.

The drug was found by police officers in pumpkins, a very popular vegetable marketed during Halloween celebrations.

The incident happened during an inspection at the Eagle Pass port of entry, a town in Maverick County that borders Nuevo León, Mexico.

US police reported that a car coming from the Mexico zone was stopped. A thorough search of the vehicle found $402,196 worth of liquid methamphetamine in vegetables.

136 condoms containing about 44 pounds (19.84 kilograms) of liquid drug were found in four pumpkins, U.S. Customs and Border Protection said in a news release.

Likewise, Eagle Pass Port of Entry interim director Elizabeth Garduno stated that police officers have seen “almost everything” when it comes to drug smuggling imports.

“This Tuesday was no exception when they found liquid methamphetamine hidden in the pumpkins. The officers used their training, experience and interviewing skills to uncover a rather novel drug smuggling technique,” Garduno explained.

It’s worth noting that methamphetamine is a narcotic that also acts as a psychostimulant, mainly by increasing the production of the hormone adrenaline. Repeated use of this drug can lead to severe dependence.

Kyiv | Russian attacks, including the use of suicide drones, killed at least eight people, including four in Kyiv on Monday morning, and targeted power plants in several regions a week after a wave of massive attacks across the country.

• Also read: Screams, panic, shots in the air: when suicide drones fall on Kyiv

• Also read: “We must not strive for civilian goals,” demands the new High Commissioner for Human Rights

• Also read: EU military support to Ukraine is increasing

The enemy “acts insidiously, killing civilians, attacking houses and infrastructure,” Ukrainian President Volodymyr Zelenskyy accused after these attacks in the social network Telegram.

“After the attack on a residential building in Kyiv, four people have already died, including a young family expecting a child. The rescue operations are not over yet. Terror must lose, and it will lose.”

He accompanied his message with several photos of the affected building, with a pile of rubble around which the emergency services were deployed.

According to the capital’s mayor Vitali Klitschko, the young woman who was killed was six months pregnant.

For its part, the Russian army congratulated itself on having achieved all its goals with “high-precision weapons”.

Five drones over Kyiv

Multiple attacks targeted key infrastructure in three regions, including the capital, leaving “hundreds of places” without power, according to Ukrainian Prime Minister Denys Chmygal, who reported “five drone strikes” of alleged Iranian attacks on Kyiv and “missile” attacks ” on the regions of Dnipropetrovsk (middle-east) and Sumy (northeast).

According to the Ukrainian emergency services, a suicide drone also hit a 9-story administration building in Kyiv. In addition to the four dead, there are 3 injured at this time.

A series of explosions could be heard in the capital early in the morning and air raid sirens had sounded just before the first explosion.

An AFP journalist saw one of these suicide drones hit a building while two police officers tried to shoot it down with their service weapons in the middle of the city.

“We’ve been here for maybe half an hour and four drones fell,” explained one of them, Yaroslav, still nervous after the shot.

cruise missile

Sacha, a young man of 22 who lives in a building nearby, said he was awakened at around 6:30 a.m. by the first blast.

“I’m scared,” he said, taking cover under a building porch.

In the Sumy region, an administrative building was destroyed by a missile attack on an electrical transformer. Shortly after noon, four dead and three people were rescued from the rubble.

One person was injured in a cruise missile attack on a transformer in the Dnipropetrovsk region. The Ukrainian Presidency claimed three rockets could have been launched.

For its part, Ukrainian nuclear operator Energoatom pointed out that the Zaporijjia (South) nuclear power plant, which had been the focus of everyone’s concerns for several months, had to be powered by its emergency diesel generators to cool its reactors after it was disconnected from the network by Russian bombardments.

“The enemy can attack our cities, but he will not be able to break us,” Volodymyr Zelenskyy promised on social networks in the morning.

Kyiv has urged the EU to impose further sanctions on Iran, which denies supplying killer drones to Russia for its offensive against Ukraine.

“Iran is responsible for killing Ukrainians. This country, which oppresses its own people, is now supplying monstrous weapons for mass murder in the heart of Europe,” criticized Mykhailo Podolyak, adviser to the Ukrainian presidency.

Tehran repeated its denials.

“Iran has not exported arms to any of the warring factions,” Iranian diplomacy spokesman Nasser Kanani said Monday.

In the south of the country, the army had previously stated that it shot down 26 Iranian Shahed 136 drones in the night from Sunday to Monday.

The EU is increasing its aid

Ukrainian Presidency Chief of Staff Andriï Yermak called on Western allies to “deploy more weapons to defend the skies and crush the enemy.”

“The EU increases its military aid to Ukraine to 3.1 billion euros and launches a military training mission for our soldiers,” he said.

The increase in European military aid and the training of 15,000 Ukrainian soldiers were on the agenda of a meeting of EU foreign ministers in Luxembourg on Monday, attended remotely by their Ukrainian counterpart Dmytro Kuleba.

On October 10, Russian bombings on a scale not seen in months left at least 19 dead and 105 wounded.

Ukraine’s western allies then promised further anti-aircraft systems, some of which have already been delivered.

Russia is on the defensive on most fronts in Ukraine, retreating north, east and south since September. The only stretch where Russian forces are still advancing is the area of ​​the city of Bakhmout (east), which Moscow has been trying to capture since the summer.

Former Russian President and current Security Council No. 2 Dmitry Medvedev has also warned Israel against supplying arms to Ukraine, believing it would “destroy” ties with Russia. Israel “appears to be preparing to supply arms to the Kiev regime,” he said on his Telegram account.

For its part, NATO on Monday began a “routine” military exercise to test its nuclear deterrent system in Europe, amid tensions exacerbated by Russia’s threat to use nuclear weapons in Ukraine.

Warm welcome! King Charles and Camilla are greeted by dozens of Union Jack-waving school children during a charity visit for young people in east London

• King, 73, and Queen Consort, 75, met with locals in Walthamstow, East London
• Monarch looked relaxed in his navy pinstripe suit as he was greeted by fans
• Camilla looked elegant in a navy blue day dress adorned with feather designs

By Claire Toureille For Web

Published: 12:21 PM BST, October 18, 2022 | Updated at 12:33pm BST, 18 October 2022

King Charles and Queen Consort were greeted by hundreds of young fans on their arrival in East London this morning.

The monarch, 73, and his wife, 75, toured Project Zero Walthamstow, an organization that works to engage young people in positive activities, promote social inclusion and strengthen community cohesion.

Charles looked dapper in a blue pinstriped suit, while Queen Consort Camilla donned a sleek blue feathered day dress.

During their visit, the couple got to know the project’s employees and young people.

King Charles and Queen Consort were greeted by hundreds of fans on their arrival in Walthamstow, East London this morning

The monarch, 73, and his wife, 75, toured Project Zero Walthamstow, an organization that works to engage young people in positive activities, promote social inclusion and strengthen community cohesion

King Charles spoke to the young fans who came to see him and his wife during their visit to East London today.

The monarch was seen chatting to a group of teenagers, who waved Union Jacks at him.

Meanwhile, Camilla beamed as she approached other youth and school children who had come for the occasion.

She was seen chatting and laughing with some of the onlookers in attendance before the pair entered the organization’s headquarters.

Camilla was seen chatting with the staff and seemed touched by the students’ love

The King was seen conversing with the schoolchildren who had come to greet him, waving Union Jacks

Her blonde tresses were styled in an impeccable blow dryer and she wore a glamorous day makeup with a swipe of mascara and bronzer to complement her natural glow.

She completed the look with a small tan leather handbag and a pair of pearl earrings.

Despite the cool temperatures of October, the couple took advantage of the London sunshine and didn’t wear sports jackets during their visit.

The king has multiplied his commitments since ascending to the throne following the death of his mother Queen Elizabeth on September 8.

Yesterday he was in good spirits during an engagement in Aberdeen.

The sun was shining when Camilla and the King arrived in East London for their visit this morning

Despite the chilly October temperature, Camilla made the most of the weather and didn’t wear a jacket

The 73-year-old monarch was visiting the city to meet families based in Aberdeen from Ukraine, Syria and Afghanistan.

Photos from the performance show His Majesty beaming as he meets with staff and refugees at a reception at City Hall.

The king donned traditional Scottish attire for the appearance, opting for a red kilt paired with a tweed blazer and waistcoat.

He wore traditional green knee socks and a traditional sporran. He completed the outfit with classic black brogues.

During the reception, the king met Inna Skvortsova, a Ukrainian who came to the city in April and now has a full-time position on the council, helping with the resettlement program.

WASHINGTON, Oct 17 (Portal) – The United States agrees with British and French assessments that Iran’s delivery of drones to Russia would violate a UN Security Council resolution enshrining the 2015 nuclear deal between Iran and Six powers approved, US State Department spokesman Vedant Patel said Monday.

“Our French and British allies today publicly made the assessment that Iran’s delivery of these UAVs (to) Russia constitutes a violation of UN Security Council Resolution 2231,” Patel told reporters, referring to unmanned aerial vehicles (UAVs) or drones. “We agree.”

Ukraine has reported a spate of Russian attacks using Iranian-made Shahed-136 drones in recent weeks. Iran denies supplying the drones to Russia, and the Kremlin has not commented.

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The State Department noted that Iranian drones were used in a morning rush-hour attack on the Ukrainian capital of Kyiv on Monday, an official said. White House spokeswoman Karinne Jean-Pierre also accused Tehran of lying when it claimed Iranian drones were not being used by Russia in Ukraine.

An engine of an unmanned aerial vehicle (UAV), which Ukrainian authorities believe to be an Iranian-made Shahed-136 suicide drone, was found after a Russian attack on fuel storage facilities amid the Russian attack on Ukraine in Kharkiv, Ukraine, on October 6. 2022. Portal/Vitalii Hnidyi/

Resolution 2231 approved the deal between Iran and Britain, China, France, Germany, Russia and the United States that restricted Tehran’s uranium enrichment activities and made it difficult for Iran to develop nuclear weapons while international sanctions were lifted.

According to the resolution, a conventional arms embargo against Iran was in effect until October 2020. Despite US efforts under former President Donald Trump, who pulled the United States out of the deal to extend the arms embargo in 2018, the Security Council refused, paving the way for Iran to resume arms exports.

However, Western diplomats said the resolution still includes restrictions on missiles and related technologies, which will last until October 2023, and include the export and purchase of advanced military systems such as drones.

“We believe that these UAVs being transferred from Iran to Russia and used by Russia in Ukraine are among the weapons that would remain embargoed under 2231,” Patel said.

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Reporting by Arshad Mohammed and Humeyra Pamuk; Edited by Nick Macfie and Grant McCool

Our standards: The Thomson Portal Trust Principles.

The international port of Mersin, Turkey, December 6, 2021. AGENCY MUSTAFA UNAL UYSAL / ANADOLU VIA AFP

Yasar’s working day comes to a painful end in a sun-soaked and deserted environment, surrounded by huge mountains of containers as far as the eye can see. He will not give his real name, nor the shipowner for whom he has been struggling since dawn, here in Mersin, in the heart of Turkey’s largest port in terms of size and area, an endless blade of concrete and steel, tearing down its docks and his Cranes in the infinite Mediterranean blue. “The fear of possible reprisals,” he slips into a confident tone. Three years of almost uninterrupted work in maritime trade logistics, it’s the kind of career that hardens a character and gives the right to some distance. “The job is tough, he admits, but maybe even tougher these days. »

With 300,000 euros net profit for the owner per cargo unloaded, Yasar prefers to remain cautious. He and his officemates do three a week. Some Turkish companies more than eighty. Enough to lead to stiff competition, especially at this time of high international tensions, when Turkey is playing a dangerous balancing act between Russia and Ukraine’s allies, here refusing to impose sanctions on Moscow and negotiating new trade deals.

re-export of goods

“The activity has never been so sustainable,” says the young logistician. Since February there has been the pandemic and now the war; trade routes are down, but at least in that area the country is doing pretty well. As of March, in the face of sanctions imposed by the United States and the European Union (EU), the Russian authorities’ resort to alternative imports has made Turkey one of their main transit hubs.

Cargoes from different countries of the world are unloaded in the ports of Mersin, Istanbul and Izmir before being transshipped into containers by local companies or subcontractors, who then transport them to Russia to the port of Novorossiïsk on the Black Sea or by sea trucks through Georgia. A similar process is used for road transport in duty-free zones. But in times of war and embargoes, this re-export of goods carried out by Turkey seems like a sleight of hand performed by a NATO prop in the eyes of Westerners. The hole in the penalty bat.

“Win win”

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Today is the 236th day of the war in Ukraine. A war that began in the winter, on February 24, with the invasion of the Russian army ordered by President Vladimir Putin. And almost 8 months later the second winter is approaching. After a summer (and an early fall) that somehow reversed the course of the conflict (with the counter-offensive throwing the invaders into trouble), Ukrainians face the approaching cold weather with concern: the energy supply is at risk, also due to recent bombings (particularly with Iranian-made drones) that make electricity and gas production even more difficult. In this episode of the Corriere Daily podcast, Odessa correspondent Marta Serafini narrates with Geneva International Red Cross spokesman Achille Després.

October 17, 2022 (change October 18, 2022 | 08:06)

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«On August 7, Gustavo Petro positioned himself as the new President of the Republic. The Colombian people have placed their trust in him and hope that with civic participation, with true democracy, social justice and national sovereignty, he will achieve complete peace,” he said in a statement.

He pointed out that his government program emphasizes decent life for all, mitigating climate change, clean energy generation, anti-poverty social shock plan and seeking peace as the first step in transforming Colombia into the world power of life.

“It will be possible to move forward on these colossal goals if people engage their opinion and support for the President who holds grudges against the Colombian right and the United States Empire,” he added.

He asserted that in order to achieve peace it was necessary to overcome war and defeat the monster of corruption, poverty and child malnutrition.

In addition, the government must comply with the 2016 peace agreement, according to what has been agreed in alliance with the farming communities in terms of political reforms, land, sacrifices, replacement of crops for illegal use.

He also added: “Prosecutions for money laundering in Colombia must begin immediately, and the United States must be called on to put an end to the hypocrisy of its drug war by allowing the CIA and DEA to fund their destabilizing activities. with drug money.”

He stressed that this will not be an easy task as the Colombian extreme right, led by Uribismo, continues to cross the path of change.

He called for the unity and mobilization of the entire Colombian people against this elite, which he described as corrupt and mafia

He emphasized that the time has come for change, for life, for love, for brotherhood, it is time to bring back the millions of hectares of devastated forests on planet earth, protect wildlife, bogs, rivers, wetlands , to protect everything that gives life, happiness and love.

He stressed that at a meeting “of the commanders of the FARC-EP Second Marquetalia” they concluded that the conditions were there “to risk everything for a full peace with social justice”.

One of the policies of the new government, which is being discussed in Congress and must be approved this week, is total peace, which includes all armed actors, with the aim of peacefully ending internal conflicts in Colombia.

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