Postural balance in COPD with obstructive sleep apnoea: a cross-sectional study.

Objective: The aim of this study was to assess the postural balance in COPD patients with obstructive sleep apnoea (OSA). Physical activity, anxiety and depression symptoms, mood, and falls were also assessed in this population. Methods: Moderate to severe COPD patients were assessed for laboratory and clinical postural balance (force platform and mini-balance evaluation systems test (Mini-BESTest)), physical activity (accelerometry), OSA (polysomnography), sleep quality (Pittsburgh Sleep Quality Index), sleepiness (Epworth Sleepiness Scale), anxiety and depression symptoms (Hospital Anxiety and Depression Scale), dyspnoea (modified Medical Research Council), clinical status (COPD Assessment Test) and mood (Brunel Mood Scale). Self-reported falls were recorded for 6 months via phone calls. Results: COPD patients (n=70) were divided according to the polysomnography findings into the no OSA (n=30), mild OSA (n=25), and moderate to severe OSA (n=15) groups. Compared to patients with no OSA, those with moderate to severe OSA (msOSA group) presented median (interquartile range) increased path length (30.5 (23.9-34.5) cm versus 39.0 (30.6-52.6) cm, anteroposterior displacement (1.89 (1.39-2.31) cm versus 2.54 (2.06-2.83) cm and postural adjustment velocity (1.02 (0.80-1.15) cm·s-1 versus 1.30 (1.02-1.76) cm·s-1) (p<0.05). No differences were observed in the Mini-BESTest scores among the groups. The msOSA group presented a greater number of recurrent fallers in the first follow-up trimester. No association was observed between postural balance and age and pulmonary function. Conclusion: Individuals with COPD and moderate to severe OSA present changes in postural balance, including broader oscillation, faster postural adjustments and a greater risk of falls than those with no OSA. Physical activity, anxiety and depression symptoms, and mood are similar between COPD patients with and without OSA.

Right ventricular dysfunction in patients with non-severe idiopathic pulmonary fibrosis: a cross-sectional prospective single-center study.

BACKGROUND: Little is known about right ventricular dysfunction in non-advanced idiopathic pulmonary fibrosis (IPF) patients without hypoxemia at rest. We evaluated it at rest and during exercise. RESEARCH DESIGN AND METHODS: 123 IPF patients were evaluated, and 27 met all the following criteria: Gender-Age-Physiology Index score ≤5, modified Medical Research Council dyspnea score ≤3, peripheral oxygen saturation ≥92% at rest, and no history of oxygen therapy. They were submitted to two-dimensional speckle-tracking echocardiography at rest and during cardiopulmonary exercise to analyze right ventricular global longitudinal strain. RESULTS: Abnormal speckle-tracking echocardiography findings were identified in 10/27 patients (37%), indicating right ventricular (RV) dysfunction. No patients had abnormalities observed in conventional echocardiographic parameters. Significant differences in mPAP were observed between patients with RV dysfunction and those without dysfunction (at rest: 26.0 ± 4.8 vs. 19.1 ± 4.2 mmHg, p = 0.001; during exercise: 51.3 ± 6.4 vs. 36.9 ± 14.7 mmHg, p = 0.002). CONCLUSIONS: RV dysfunction was detected in 37% of non-advanced IPF patients and early recognition was only possible using speckle-tracking echocardiography. Special attention should be given to these patients as RV dysfunction is suggestive of worse prognosis. These patients could benefit from new specific drugs or even oxygen therapy for transitory hypoxia.

Lung MRI to predict response or lack of response to treatment in interstitial lung disease: initial observations on SSFSE/PROPELLER T2 match/mismatch.

BACKGROUND: Ground-glass opacities (GGO) are frequently found in interstitial lung diseases (ILD) and may represent either active inflammation or subresolution interstitial fibrosis. We sought to investigate the ability of lung MRI to predict treatment response in individuals with ILD presenting with predominant GGO. Methods: prospective cohort, 15 participants presenting with ILD manifested as predominant GGO and referred for a new treatment regimen with a systemic glucocorticoid and/or an immunosuppressive agent, underwent 1.5 T lung MRI. SSFSE/PROPELLER T2 mismatch sign, relative signal intensity on T2-weighted images and relative enhancement of lung lesions were compared to functional response, defined as a greater than 10% increase in forced vital capacity in 10 weeks (primary endpoint). RESULTS: SSFSE/PROPELLER T2 match/mismatch was able to discriminate responders from nonresponders for the primary endpoint in 12 of 15 participants (80% accuracy, p = 0.026) for readers 1 and 2, and in 13 of 15 participants (87% accuracy, p = 0.011) for reader 3, with interrater agreement of 87% between readers 1 and 2 (Cohen's kappa coefficient of 0.732) and 93% between readers 1/2 and 3 (Cohen's kappa coefficient of 0.865). CONCLUSIONS: SSFSE-PROPELLER T2 match/mismatch was predictive of treatment response status in this group of ILD patients. Abbreviations FVC: forced vital capacityGGO; ground-glass opacities; HRCT: High-Resolution Computed Tomography; ILD: interstitial lung disease; LAVA: Liver Acquisition with Volume Acceleration; mMRC: modified Medical Research Council dyspnea score; MRI: Magnetic Resonance Image; PROPELLER: Periodically Rotated Overlapping Parallel Lines with Enhanced Reconstruction; SI: signal intensity; SSFSE: Single-Shot Fast Spin Echo.

Noninvasive assessment of peripheral skeletal muscle weakness in idiopathic pulmonary fibrosis: a pilot study with multiparametric MRI of the rectus femoris muscle.

BACKGROUND: To investigate differences in magnetic resonance imaging (MRI) features of rectus femoris muscle between idiopathic pulmonary fibrosis (IPF) patients and healthy volunteers. METHODS: Thirteen IPF patients with GAP Index stage II disease were subjected to pulmonary function tests, 6-minute walk test (6MWT), quadriceps femoris muscle strength measurement and MRI of the thigh at rest. At MRI, muscle cross-sectional areas, T2 and T2* relaxometry, and 3-point Dixon fat fraction were measured. The results were compared to those of eight healthy sedentary volunteers. RESULTS: IPF patients had significantly lower %predicted FVC, FEV1 and DLCO (p<0.001 for the three variables) and walked significantly less in the 6MWT (p=0.008). Mean quadriceps femoris muscle strength also was significantly lower in IPF patients (p=0.041). Rectus femoris muscle T2* measurements were significantly shorter in IPF patients (p=0.027). No significant intergroup difference was found regarding average muscle cross-sectional areas (p=0.790 for quadriceps and p=0.816 for rectus femoris) or rectus femoris fat fraction (p=0.901). Rectus femoris T2 values showed a non-significant trend to be shorter in IPF patients (p=0.055). CONCLUSIONS: Our preliminary findings suggest that, besides disuse atrophy, other factors such as hypoxia (but not inflammation) may play a role in the peripheral skeletal muscle dysfunction observed in IPF patients. This might impact the rehabilitation strategies for IPF patients and warrants further investigation.

Multiple myeloma and secondary plasma cell leukemia.

Plasma cell leukemia is very rare condition characterized by malignant proliferation of plasma cells in blood and bone marrow, which is aggressive and has a short survival even with conventional treatment. This ominous entity may be primary, or develops secondarily during the course of multiple myeloma. A 53-year-old Brazilian woman with multiple myeloma is described with bone marrow evaluation revealing 25% plasma cells. The quantification of plasma cell infiltration in bone marrow aspirate and immunohistochemistry study revealed consistent features of myeloma and plasma cell leukemia, and lambda light chain expression. Worthy of note was the absence of CD56 expression and the expression of CD20; moreover, 23% of circulating plasma cells were detected in peripheral blood smears. Therefore, the diagnosis of plasma cell leukemia was characterized and therapeutic schedules with dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide, and etoposide were utilized. With significant clinical improvement, the patient is currently waiting for bone marrow transplant.

Paravertebral abscess by Escherichia coli and melanoma metastasis in an older woman.

Paravertebral abscesses are usually caused by Staphylococcus aureus, and often affect older people with diabetes mellitus or immunosuppression. We report a huge lumbar abscess caused by Escherichia coli in an 81-year-old woman with diabetes and melanoma metastasis. Lumbar vertebra and surrounding soft tissues were involved by the Gram-negative infection, and imaging features were indicative of malignant condition. Diagnosis was established by images of magnetic resonance, histopathology, and bacterial culture from abscess fluid. This condition poses diagnosis challenges and seems to be increasing in frequency. Reports of case studies might enhance the suspicion index of primary care physicians about this entity.