Adverse-outcomes related to sarcopenia are mostly mentioned as physical disability. As the other skeletal muscles, respiratory muscles may also be affected by sarcopenia. Respiratory muscle strength is known to affect pulmonary functions. Therefore, we aimed to investigate the relations between extremity muscle strength, respiratory muscle strengths and spirometric measures in a group of male nursing home residents. Among a total of 104 male residents, residents with obstructive measures were excluded and final study population was composed of 62 residents. Mean age was 70.5 ± 6.7 years, body mass index: 27.7 ± 5.3 kg/m2 and dominant hand grip strength: 29.7 ± 6.5 kg. Hand grip strength was positively correlated with maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) (r = 0.35, p < 0.01 and r = 0.26, p < 0.05, respectively). In regression analysis, the only factor related to MIP was hand grip strength; among spirometric measures only parameter significantly related to grip strength was peak cough flow (PCF). The association of PCF with grip strength disappeared when MIP alone or "MIP and MEP" were included in the regression analysis. In the latter case, PCF was significantly associated only with MIP. We found peripheric muscle strength be associated with MIP and PCF but not with MEP or any other spirometric parameters. The relation between peripheral muscle strength and PCF was mediated by MIP. Our findings suggest that sarcopenia may affect inspiratory muscle strength earlier or more than the expiratory muscle strength. Sarcopenia may cause decrease in PCF in the elderly, which may stand for some common adverse respiratory complications.
Introduction of self-management plans improved illness control and quality of life in asthma patients. Use of the PFM and the presence of higher RIELCS and lower BDI scores can be used to predict compliance with the action plans.
Turkish national guidelines recommend peak expiratory flow (PEF) measurements for assessing the reversibility of airflow obstruction in the primary care setting because it is cost-effective and practical. In this study, the usefulness and reliability of PEF as an alternative parameter to forced expiratory volume in 1 second (FEV 1) as a reversibility test was investigated. Eighty-three subjects with asthma symptoms and airflow obstruction on spirometry met inclusion criteria. The mean age of the subjects was 42 ± 17.5 years; 52% were men. The FEV 1 % was between 53% and 80% in the study population. PEF was assessed using a manual peak flow meter, while FEV 1 was obtained from the spirographic curve. A positive bronchodilator response was defined as an increase in FEV 1 of >12% predicted after inhaling 400 µg of salbutamol. This response was compared with an increase in PEF% from baseline with cutoff values of 15% and 20%. FEV 1 >12%, PEF >15%, and PEF >20% bronchodilator response was observed in 59%, 61%, and 49% of patients, respectively. There was a weak correlation between postbronchodilator FEV 1 and PEF increase (r = 0.275, P = .012). An increase in PEF >15% showed a sensitivity of 74%, specificity of 58%, positive predictive value (PPV) of 74%, and negative predictive value (NPV) of 59% compared with an FEV 1 response of >12%. Similarly, an increase of PEF >20% had a sensitivity of 54%, specificity of 57%, PPV of 65%, and NPV of 45%. The clinical value of PEF measurements in the diagnosis of reversible obstructive airway disease was less reliable than FEV 1. Therefore, it should be reevaluated for widespread usage.
Background:Nervous system involvement of Behçet syndrome (neuroBS) is a serious, but infrequent manifestation of Behçet syndrome (BS). Although many BS patients present with signs and symptoms related to the nervous system, several of these are diagnosed with conditions other than neuroBS. The differential diagnosis may be difficult in such patients.Objectives:To identify conditions mimicking neuroBS among patients with BS and to determine clinical, laboratory and imaging findings that may help the differential diagnosis.Methods:We retrospectively screened the charts of 500 BS patients who were registered to our clinic between February 2012 and April 2015, to identify those who were referred to neurology at any time during their follow-up. We follow our BS patients in a multidisciplinary clinic and all patients with a sign or symptom related to the nervous system are seen by one of the neurologist members of the clinic. The final diagnoses, as well as presenting signs and symptoms, laboratory and imaging results and results of any other diagnostic modalities were retrieved from patient charts. Patients who did not have a follow-up visit during the last 3 months were invited to the clinic for their final condition. Those who were not able to come, or one of their family members if they were not able to talk, were interviewed on the phone.Results:Among the 500 BS patients who were screened, 116 (23%) were referred to neurology (53 men, 63 women, mean age 32.8 (±9.8), 98 (84%) fulfilled ISG criteria). Among these, 29 (5.8%) were diagnosed with neuroBS, 30 (6%) had other conditions related to the nervous system, 46 (9.2%) were not diagnosed with a nervous system disorder and their symptoms disappeared and 11 (2.2%) were inconclusive and lost to follow-up. Of the 29 patients with neuroBS, 20 had parenchymal involvement, 7 had cerebral venous sinus thrombosis, 1 had concurrent parenchymal involvement and cerebral venous sinus thrombosis and 1 had atypical neuroBS. Of the 30 BS patients who were diagnosed with another nervous system condition, 14 (2.8%) had primary headache syndromes including tension type headache (n=5) and migraine (n=9), 6 (1.2%) had psychiatric disorders including psychotic disorder (n=1), depression (n=4) and somatization disorder (n=1), the remaining patients had other diagnoses which were entrapment neuropathy (n=2), epilepsy, glial tumor, multiple sclerosis, Meniere’s disease, optic neuritis, neuroretinitis, steroid myopathy and polyneuropathy in one patient each. Presentation features such as cerebellar symptoms, motor symptoms, visual problems, altered consciousness, seizure, fever and facial palsy were more common among patients with neuroBS, whereas sensory symptoms and isolated headache were more common among BS patients with other nervous system conditions (Table).Table.Clinical characteristics of patients with neuroBS versus other diagnosesClinical findings at presentationBS patients with nervous system involvement (neuroBS) (n=29)BS patients with other nervous system conditions (n=30)Only headache2 (7%)17 (56%)Cerebellar symptoms*8 (27%)4 (13%)Motor symptoms*4 (14%)2 (7%)Sensory symptoms*3 (10%)5 (17%)Visual problems*(diplopia, blurred vision)9 (31%)1 (3%)Cognitive symptoms*2 (7%)2 (7%)Other* (Alteration of consciousness, seizure, fever, facial palsy)9 (31%)1 (3%)* Accompanying more than 1 symptom/signConclusion:Nervous system conditions other than neuroBS are common in patients with BS who present with nervous system findings. Caution is required to avoid misdiagnosis of these patients as neuroBS.Disclosure of Interests:Elif Dincses: None declared, E. Buse Caliskan: None declared, Z. Ece Kaya: None declared, Ugur Uygunoglu: None declared, Melih Tutuncu: None declared, Sabahattin Saip: None declared, Aksel Siva: None declared, Melike Melikoglu: None declared, Vedat Hamuryudan Speakers bureau: Pfizer, AbbVie, Amgen, MSD, Novartis, UCB, Gulen Hatemi Grant/research support from: BMS, Celgene Corporation, Silk Road Therapeutics – grant/research support, Consultant of: Bayer, Eli Lilly – consultant, Speakers bureau: AbbVie, Mustafa Nevzat, Novartis, UCB – speaker
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