Simple bedside tests of muscle strength and function correlate with computed tomography-skeletal muscle index for assessment of sarcopenia in cirrhosis.

BACKGROUND: Sarcopenia assessment can be done by skeletal muscle index (SMI) or bedside tests such as handgrip strength (HGS) and gait speed (GS). GOALS: This study evaluated the correlations of HGS and GS with SMI, health-related quality of life (HRQOL) and cognition and assessed them as predictors of mortality. STUDY: As many as 116 outpatients with cirrhosis were included in this prospective cohort study. Assessment for sarcopenia was done by SMI, HGS and GS. HRQOL was assessed using the chronic liver disease questionnaire (CLDQ) and fatigue severity scale (FSS). Cognition was assessed by mini-mental state examination (MMSE). Correlations of HGS and GS with SMI, HRQOL and cognition were analyzed. Area under the curve (AUCs) were calculated to compare them as predictors of mortality. RESULTS: Alcoholic liver disease (47.4%) was the commonest etiology of cirrhosis followed by hepatitis C (12.9%). Sarcopenia was diagnosed in 64 (55.2%) patients. A strong correlation was seen between SMI and HGS (ρ = 0.78) and GS (ρ = 0.65). AUCs of GS (0.91 (95% confidence interval [CI], 0.85-0.96) was maximum, followed by HGS (95% CI, 0.86 [0.78-0.93] and SMI [95% CI, 0.8 0.71-0.88]) in predicting mortality (p > 0.05). CLDQ (3.2 vs. 5.6, p < 0.01) and MMSE scores (24.3 vs. 26.3, p < 0.01) were lower, whereas FSS score (5.7 vs. 3.1, p < 0.01) was higher in patients with sarcopenia. CLDQ (ρ = 0.83) and MMSE (ρ = 0.73) showed the strongest correlation with HGS, whereas FSS correlated well (ρ = 0.77) with GS. CONCLUSIONS: Bedside tests of muscle strength and function, including HGS and GS, correlate strongly with SMI for sarcopenia assessment and prediction of mortality in patients with cirrhosis.

A Predictor of Difficult Airway: The Tasli Classification in Transnasal Flexible Laryngoscopy.

INTRODUCTION: Difficult airway is defined as difficulty or failure in one or more steps in upper airway management. Evaluation of the upper airway with physical examination methods and endoscopic devices is crucial in predicting difficult airway. The aim of this study was to evaluate bedside tests, Cormack Lehane (CL) and Tasli Classification (TC) scores of the patients and it was aimed to reveal the role of TC which will be performed preoperatively as a predictor of difficult tracheal intubation (DTI). METHODS: The study included a total of 98 patients who underwent surgical treatment under general anesthesia. Demographic data, including age, gender, and body mass index (BMI), and bedside tests consisting Modified Mallampati Classification (MMC), thyromental (TD) and sternomental (SD) distances, neck circumference (NC), interincisor distance (IID), CL and TC were recorded. RESULTS: Evaluation was made of 64 (65.3%) male and 34 (34.7%) female patients ranging in age from 18 to 84 years (mean age: 50.35 ± 0.47 years). The successfully intubated patients (SIP)  group comprised 68 (69.4%) patients, and the difficult intubation patients (DIP) group, 30 (30.6%). According to CL, the numbers of SIP and DIP constituting grade 1 was 29 (42.6%) and one (3.3%); grade 2a was 29 (42.6%) and one (3.3%); grade 2b was eight (11.8%) and three (10%); grade 3a was one (1.5%) and six (20%); grade 3b was one (1.5%) and 14 (46.7%) respectively. Grade 4 was only detected in the DIP group in 5 (16.7%) patients. According to TC, the numbers of SIP and DIP constituting grade 1 was 20 (29.4%) and 1 (3.3%); grade 2a was 37 (54.4%) and seven (23.3%); grade 2b was 10 (14.7%) and 18 (60%); grade 3 was one (1.5%) and two (6.7%) respectively. Grade 4 was only detected in the DIP group in two (6.7%) patients. CONCLUSION: The TC, CL, NC and BMI scores were higher in the DIP group and higher TC scores (grade 2b, 3, and 4) can be a predictor of difficult airway. However, it may be more beneficial to use TC as a complementary diagnostic tool with bedside tests such as NC, SM, TM and MMC, rather than used alone.

Clinical performance of lung ultrasound in predicting ARDS morphology.

BACKGROUND: To assess diagnostic performance of lung ultrasound (LUS) in identifying ARDS morphology (focal vs non-focal), compared with the gold standard computed tomography. METHODS: Mechanically ventilated ARDS patients undergoing lung computed tomography and ultrasound were enrolled. Twelve fields, were evaluated. LUS score was graded from 0 (normal) to 3 (consolidation) according to B-lines extent. Total and regional LUS score as the sum of the four ventral (LUSV), intermediate (LUSI) or dorsal (LUSD) fields, were calculated. Based on lung CT, ARDS morphology was defined as (1) focal (loss of aeration with lobar distribution); (2) non-focal (widespread loss of aeration or segmental loss of aeration distribution associated with uneven lung attenuation areas), and diagnostic accuracy of LUS in discriminating ARDS morphology was determined by AU-ROC in training and validation set of patients. RESULTS: Forty-seven patients with ARDS (25 training set and 22 validation set) were enrolled. LUSTOT, LUSV and LUSI but not LUSD score were significantly lower in focal than in non-focal ARDS morphologies (p < .01). The AU-ROC curve of LUSTOT, LUSV, LUSI and LUSD for identification of non-focal ARDS morphology were 0.890, 0.958, 0.884 and 0.421, respectively. LUSV value ≥ 3 had the best predictive value (sensitivity = 0.95, specificity = 1.00) in identifying non-focal ARDS morphology. In the validation set, an LUSV score ≥ 3 confirmed to be highly predictive of non-focal ARDS morphology, with a sensitivity and a specificity of 94% and 100%. CONCLUSIONS: LUS had a valuable performance in distinguishing ARDS morphology.

The simple and fast swallowing function assessment in acute stroke patients.

OBJECTIVE: The dysphagia associated pulmonary aspiration is one of the important reasons for mortality and morbidity in stroke. In this study, we evaluated the early swallowing functions of the acute ischemic stroke patients, and tried to choose the right way to start feeding with simple tests. METHODS: Seventy-three inpatients with acute stroke were included in this study. Age, gender, type of stroke, NIHSS and RANKIN scores, risk of aspiration and feeding route were recorded for all the subjects. Dysphagia was evaluated with the bedside clinical evaluation of swallowing function score (BDS) tests. These BDS tests are the assessment of dysphagia with neurological examination score (DSNE) and the bedside water drinking test (BWT) and the Swallowing score (SS) ratio (combining BWT and DSNE scores). All tests to evaluate swallowing were planned to be carried out 24 hours after the last known time of the patient's healthy and 48 hours after hospitalized. The tests were performed in awake patients who were able to manage to cooperate at the scheduled time. In addition, stroke patients were evaluated quantitatively using the Gugging Swallowing Screen (GUSS) test for dysphagia and compared with BDS tests. All patients were evaluated for aspiration pneumonia seven days after admission. If the patients had drowsiness or were unable to cooperate, they were not included in this study. RESULTS: Seventy-three (26F/47M) patients were included in this study if they were conscious and the Glasgow coma scale was above 10 points. When only BDS tests were performed, we decided that 74% (n=54) of the patients could be fed by the oral route, 13.7% of the patients could be fed only by NG route (n=10) and the patients who had the worst BWT and DSNE scores preferred to be feed with PEG route (11% of all the patients, n=8). In 41.1% of the patient (n=30) established the risk of aspiration on referral clinic and 23.3% of the patients (n=17) developed aspiration pneumonia in the clinical follow-up. When 30.1% (22) of the patients had dysphagia with GUSS test, 23.3% (n=17) of the patients were dysphagic with DSNE and 30.1% of the patients (n=22) were dysphagic with BWT and 22% (n=16) of the patients were moderate-severe, 11% (n=8) of the patients were mild dysphagic with the SS ratio. CONCLUSION: These BDS tests concluded are fast and reliable methods for evaluating the dysphagia and risk of aspiration pneumonia without laborious and very few clinically applicable methods, such as endoscopic or video fluoroscopy, in patients who are hospitalized with stroke.

Migraine patients consistently show abnormal vestibular bedside tests / Pacientes enxaquecosos consistentemente apresentam testes vestibulares de beira-de-leito anormais

Migraine and vertigo are common disorders, with lifetime prevalences of 16% and 7% respectively, and co-morbidity around 3.2%. Vestibular syndromes and dizziness occur more frequently in migraine patients. We investigated bedside clinical signs indicative of vestibular dysfunction in migraineurs. Objective To test the hypothesis that vestibulo-ocular reflex, vestibulo-spinal reflex and fall risk (FR) responses as measured by 14 bedside tests are abnormal in migraineurs without vertigo, as compared with controls. Method Cross-sectional study including sixty individuals – thirty migraineurs, 25 women, 19-60 y-o; and 30 gender/age healthy paired controls. Results Migraineurs showed a tendency to perform worse in almost all tests, albeit only the Romberg tandem test was statistically different from controls. A combination of four abnormal tests better discriminated the two groups (93.3% specificity). Conclusion Migraine patients consistently showed abnormal vestibular bedside tests when compared with controls.

Enxaqueca e vertigem são desordens comuns, com prevalência de 16% e 7% respectivamente, e comorbidade em torno de 3,2%. Síndromes vestibulares e tonturas ocorrem mais frequentemente em enxaquecosos. Pesquisamos alterações vestibulares utilizando testes de beira-de-leito em enxaquecosos. Objetivo Verificar se as respostas dos reflexos vestíbulo-ocular, vestíbulo-medular e risco de quedas medidas por 14 testes de beira-de-leito são diferentes comparando-se enxaquecosos sem vertigem, e controles. Método Estudo transversal com sessenta pessoas, 30 enxaquecosos; 25 mulheres, 19-60 anos; e trinta controles saudáveis pareados por sexo e idade. Resultados Houve tendência de pior desempenho entre enxaquecosos em quase todos testes, porém apenas o teste de Romberg tandem foi estatisticamente diferente dos controles. Uma combinação de quatro testes anormais discrimina os grupos com especificidade de 93,3%. Conclusão O grupo de enxaquecosos mostrou consistentemente testes vestibulares de beira-de-leito anormais quando comparados a controles.