Association of sarcopenia with osteoporosis in patients with chronic obstructive pulmonary disease

Objectives@#Systemic consequence of Chronic Obstructive Pulmonary Disease (COPD) is associated with progressive loss of muscle mass and function. Preliminary studies showed presence of sarcopenia in COPD leads to reduced pulmonary function and quality of life; studies on whether this condition results in consequent loss of bone mineral density (BMD) is still inconsistent. This study aims to examine the association of sarcopenia in COPD with osteoporosis. @*Methods@#This is a post-hoc analysis of a study on forty-one (n ¼ 41) participants with COPD seen in a tertiary public hospital in Manila, Philippines who underwent pulmonary function test and dual-energy x-ray absorptiometry. Sarcopenia was defined using a Philippine-based criteria of low fat free mass index (FFMI) and low muscle strength - hand grip strength, and osteoporosis using World Health Organization T-score diagnostic criteria. @*Results@#The prevalence of osteoporosis among COPD is 44%, and 63% in COPD with sarcopenia. There was no statistical difference seen in pulmonary function variables between COPD with and without osteoporosis. Significant positive correlations were observed between Forced Expiratory Volume in 1 s, FFMI, and appendicular lean muscle with total body BMD. Sarcopenia in COPD was associated with significantly increased risk for osteoporosis. @*Conclusions@#High prevalence rate of osteoporosis, and even higher among sarcopenic Filipino COPD patients should be further studied. The findings also suggest that sarcopenia in COPD is associated with increased risk of osteoporosis, and osteoporosis alone does not seem to affect lung function.

Balanced Crystalloids versus Normal Saline as Intravenous Fluid Therapy among Critically Ill patients: A meta-analysis of randomized controlled trials

Introduction@#Recent studies on critically ill adults has shown that use of normal saline with its supraphysiologic chloride content has been associated with an increased incidence of hyperchloremic metabolic acidosis, acute kidney injury (AKI), renal replacement therapy (RRT), hypotension and death. The objective of this meta-analysis was to assess the clinical outcomes associated with the use of balanced crystalloids versus normal saline solution.@*Methods@#We searched PubMed/MEDLINE, Embase and Cochrane Library (CENTRAL) databases in accordance with PRISMA guidelines. Our inclusion criteria were the following: randomized controlled trials, adult critically ill patients, comparisons between patients receiving either balanced crystalloids (lactated ringer’s solution, plasma-lyte) or normal saline, and at least one endpoint that measure intensive care unit mortality, risk of AKI (defined as stage 2 or greater in the RIFLE criteria) and risk of RRT. Risk ratios (RRs) and confidence intervals (C.I) were calculated via Review Manager Version 5.3 using the fixed-effect modelling.@*Results@#A total of four randomized controlled trials, which were all assessed to be good quality and low risk of bias, with 19,105 patients were included. Use of balanced crystalloids showed a trend towards lower incidence of AKI (RR 0.94, 95% C.I [0.87-1.02], P=0.69), RRT use (RR 0.91, 95% C.I. [0.771.07], P=0.29) and ICU mortality (RR 0.91, 95% C.I. [0.82-1.01], P=0.95). There is no significant heterogeneity identified.@*Conclusion@#Use of balanced crystalloids as intravenous fluid therapy among critically ill patients demonstrated a trend toward lower incidence of AKI, RRT and ICU mortality, compared to normal saline solution.

Evidence from a Multidimensional Health Assessment Questionnaire (MDHAQ) of the Value of a Biopsychosocial Model to Complement a Traditional Biomedical Model in Care of Patients with Rheumatoid Arthritis

Patient self-report questionnaires such as a multidimensional health assessment questionnaire (MDHAQ) have advanced knowledge concerning prognosis, care, course and outcomes of rheumatoid arthritis (RA). The MDHAQ may overcome some limitations of a "biomedical model," the dominant paradigm of contemporary medical services, including limitations of laboratory tests, radiographs, joint counts, and clinical trials, to predict and depict the long-term course and outcomes of RA. A complementary "biopsychosocial model" captures components of a patient medical history on patient questionnaires as quantitative, standard, "scientific" scores for physical function, pain, fatigue, and other problems, rather than as 'subjective" narrative descriptions. A rationale for a biopsychosocial model in RA includes the importance of a patient history in diagnosis and management compared to biomarkers in many chronic diseases such as hypertension and diabetes. Some important observations which support a biopsychosocial model in RA based on patient questionnaires include that MDHAQ physical function scores are far more significant than radiographs or laboratory tests to predict severe RA outcomes such as work disability and premature death; patient self-report measures are more efficient than tender joint counts and laboratory tests to distinguish active from control treatments in RA clinical trials involving biological agents; and MDHAQ scores are more likely than laboratory tests to be abnormal at presentation and to document incomplete responses to methotrexate at initiation of biological agents. Patient questionnaires can save time for doctors and patients, and improve doctor-patient communication. A standardized database of MDHAQ scores consecutive patients over long periods might be considered by all rheumatologists in routine clinical care.

Reversible splenial lesion syndrome in neuroleptic malignant syndrome

Background: Reversible focal lesions in the splenium of the corpus callosum (SCC) or reversible splenial lesion syndrome are rare and little is known about their pathophysiology. Case summary: The authors describe a case of a 65-year-old female who presented with fever, abnormal behaviour and mild hypernatremia. She was on neuropsychiatric treatment for bipolar disorder but denied any history of seizure. After an extensive workout to exclude infection, a clinical diagnosis of neuroleptic malignant syndrome (NMS) was made. Initial magnetic resonance imaging (MRI) of the brain showed a lesion in the SCC characterized by high-signal intensity on T2-weighted and FLAIR sequences with reduced signal intensity on T1-weighted sequence. Diffuse weighted imaging (DWI) showed restricted diffusion. There was no enhancement following Gadolinium administration. The follow-up MRI 8 weeks later showed complete resolution of the SCC lesion. Conclusion: While the pathophysiology of reversible SCC lesions is still unclear, this case highlights the need to consider NMS in the differential diagnosis of reversible splenial lesion of the corpus callosum.