Background:
Upper limb (UL) muscle dysfunction is a common extrapulmonary manifestation of chronic obstructive pulmonary disease (COPD). UL muscle dysfunction is associated with muscle weakness, ...dyspnea, and exercise intolerance. Although upper limb exercise training (ULET) is typically incorporated in pulmonary rehabilitation programs, its effects on UL muscle strength remains unclear.
Objectives:
The purpose of this systematic review was to investigate the effectiveness of ULET, in UL muscle strength of people with COPD.
Design:
This is systematic review and meta-analysis study.
Data Sources and Methods:
Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Protocols 2020 guidelines were used for this study. PubMed, Cochrane, CINAHL Plus and SPORTDiscus and clinicaltrials.gov registry were searched from inception to July 2022. Included studies were randomized controlled trials, assessing the effectiveness in muscle strength of ULET, compared with other types of upper or lower limb exercise or no exercise. The quality and risk of bias were assessed using the Physiotherapy Evidence Database (PEDro) scale and certainty of evidence with the Grading of Recommendations, Assessment, Development, and Evaluations approach. Treatment effects of ULET were calculated using standardized mean differences and 95% confidence intervals.
Results:
Twenty-four studies, with a total sample of 882 patients, were included. Most studies were of moderate quality and high risk of bias. Very low to low certainty evidence indicates a significant difference in UL muscle strength in favor of resistance ULET, compared with lower limb exercise alone or no exercise. No significant differences were found in different types of ULET comparisons.
Conclusion:
The results of this review showed that resistance ULET could improve UL muscle strength in people with COPD. Most studies, however, were of moderate quality and high risk of bias. Further studies with larger sample sizes, better methodological quality, and standardized training protocols are needed to confirm these findings.
Community-acquired pneumonia (CAP) remains the leading cause of hospitalization among infectious disease in Europe, and a major cause of morbidity and mortality. In order to determine and ...characterize the aetiology of CAP in hospitalized adults in Cyprus, respiratory and blood samples were obtained from hospitalized patients with CAP, and analyzed using Multiplex Real-Time PCR/RT-PCR, and ID/AMR enrichment panel (RPIP) analysis. Probe-based allelic discrimination was used to investigate genetic host factors in patients. The aetiology could be established in 87% of patients. The most prevalent viral pathogens detected were influenza A, SARS-CoV-2, and human rhinovirus. The most common bacterial pathogens detected were Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae. Antimicrobial resistance genes were identified in 23 patients. S. aureus was the most common AMR correlated strain in our study. A positive correlation was detected between bacterial infections and the NOS3 rs1799983 G allele and the FCGR2A rs1801274 G allele. A positive correlation was also detected between the TNF-α rs1800629 A allele and sepsis, while a negative correlation was detected with the ACE rs1799752 insertion genotype and the severity of pneumonia. In conclusion, the targeted NGS panel approach applied provides highly sensitive, comprehensive pathogen detection, in combination with antimicrobial resistance AMR insights that can guide treatment choices. In addition, several host factors have been identified that impact the disease progression and outcome.
Circadian rhythm sleep-wake disorder (CRSWD) is an often-misdiagnosed group of sleep disturbances with limited data concerning diagnostic and therapeutic algorithms in the general population. ...Therefore, reported prevalence varies in the literature due to different case definitions, methodological, and environmental factors.
The purpose of our cross-sectional study was to estimate the prevalence of CRSWD in the general population of Cyprus and to suggest clinical parameters for the assessment of atypical sleep schedules. The estimation was carried out by introducing normal preset sleep time limits, according to the imposed local environment and by administering well-established questionnaires for symptoms and consequence dysfunction, as objective evaluation tools.
In a nationwide epidemiological survey, 4118 Cypriot adult participants, selected and stratified to represent the general population, were interviewed on sleep habits and complaints by computer-assisted telephone interviewing (CATI). In the second stage, 250 adults were randomly selected from the initial representative sample, for a CRSWD assessment. According to the proposed diagnostic criteria, patients were interviewed about sleepiness and/or insomnia, and daytime dysfunction (fatigue, anxiety, and depression). They were also assessed by a weekly sleep diary for sleep schedules. Finally, all participants underwent a Type III Sleep Study, to rule out obstructive sleep apnea.
From 195 enrolled participants (response rate 78%), 25 individuals (12.8%) met the criteria for CRSWD. The two most prevalent disorders were delayed sleep-wake phase disorder (DSWPD) (10pts, 5.1%) and shift work sleep disorder (SWD) (13, 6.7%). Less prevalent disorders included irregular sleep-wake rhythm disorder (ISWRD) (1, 0.5%) and advanced sleep-wake phase disorder (ASWPD) (1, 0.5%).
According to our data, CRSWDs are common in the general population of Cyprus, especially DSWPD and SWD. Affected individuals usually suffer from sleep deprivation and complain about insomnia, sleepiness and depression.
Obstructive sleep apnea (OSA) is a chronic and prevalent disorder, strongly associated with cardiovascular disease (CVD). The apnea-hypopnea index (AHI), or respiratory event index (REI), and the ...oxygen desaturation index (ODI) are the clinical metrics of sleep apnea in terms of diagnosis and severity. However, AHI, or REI, does not quantify OSA-related hypoxemia and poorly predicts the consequences of sleep apnea in cardiometabolic diseases. Moreover, it is unclear whether ODI correlates with CVD in OSA. Our study aimed to examine the possible associations between respiratory sleep indices and CVD in OSA, in a non-clinic-based population in Cyprus. We screened 344 subjects of a stratified, total sample of 4118 eligible responders. All participants were adults (age 18+), residing in Cyprus. Each patient answered with a detailed clinical history in terms of CVD. A type III sleep test was performed on 282 subjects (81.97%). OSA (REI ≥ 15) was diagnosed in 92 patients (32.62%, Group A). REI < 15 was observed in the remaining 190 subjects (67.37%, Group B). In OSA group A, 40 individuals (43%) reported hypertension, 17 (18.5%) arrhythmias, 10 (11%) heart failure, 9 (9.8%) ischemic heart disease and 2 (2%) previous stroke, versus 46 (24%), 21 (11%), 7 (3.7%), 12 (6.3%) and 6 (3%), in Group B, respectively. Hypertension correlated with REI (p = 0.001), ODI (p = 0.003) and mean SaO2 (p < 0.001). Arrhythmias correlated with mean SaO2 (p = 0.001) and time spent under 90% oxygen saturation (p = 0.040). Heart failure correlated with REI (p = 0.043), especially in the supine position (0.036). No statistically significant correlations were observed between ischemic heart disease or stroke and REI, ODI and mean SaO2. The pathogenesis underlying CVD in OSA is variable. According to our data, hypertension correlated with REI, ODI and mean SaO2. Arrhythmias correlated only with hypoxemia (mean SaO2), whereas heart failure correlated only with REI, especially in the supine position.
ABSTRACT Objective: To investigate the efficacy of upper limb exercise training (ULExT) in improving the performance of activities of daily living (ADL) that involve the upper limbs (UL) in patients ...with COPD. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used in this systematic review. PubMed and EBSCOhost databases were searched to identify randomized controlled trials involving adults with COPD who underwent ULExT, compared with those who underwent other types of exercise or no exercise, in order to assess the performance of ADL that involve the UL. The methodological quality of the selected studies was assessed using the Physiotherapy Evidence Database scale. Results: Five studies, with a total sample of 173 subjects, met the inclusion criteria. The results of the selected studies showed that ULExT is safe and can significantly improve the performance of ADL that involve the UL in patients with COPD. However, there were inconsistencies in the results, especially regarding the perception of symptoms during ADL. The small number of studies included and their methodological quality do not allow for firm conclusions. Conclusions: The findings of this review revealed that ULExT is a safe therapeutic approach and can improve the performance of ADL that involve the UL in patients with COPD, but the results are unclear. Further investigation through well-designed randomized trials is warranted to determine the effectiveness of ULExT in improving the performance of ADL that involve the UL in patients with COPD.
Mucormycosis is a life-threatening fungal infection whose incidence has been rising recently, mainly due to the increasing use of immunosuppressive and corticosteroid treatment. In previous decades, ...mucormycosis was associated with a very poor prognosis as mortality was approximately 100%. Mortality rates reported in recent literature have only slightly improved despite the availability of targeted therapy with amphotericin B. Pulmonary mucormycosis is characteristically encountered in severely immunocompromised hosts, while rhino-orbital disease is often seen in individuals with diabetes mellitus. We report a rare case of fulminant pulmonary mucormycosis as an exceptionally rare complication of corticosteroid treatment in a 76-year-old patient with chronic obstructive pulmonary disease (COPD) and diabetes. The patient had presented with typical symptoms of an infective COPD exacerbation. The interesting aspects of our case were the absence of malignancy or immunosuppression, the isolation of
species, and the fungal invasion of the pleura and pericardium. Unfortunately, our patient died on the 49th day of hospitalisation, despite appropriate treatment.
Pulmonary mucormycosis in patients with known respiratory disease may mimic an exacerbation of their lung disease, thus delaying diagnosis.Pulmonary mucormycosis can complicate corticosteroid treatment in elderly individuals with other predisposing factors, which is an emerging clinical concern.Pulmonary mucormycosis remains a potentially fatal disease, although early diagnosis and appropriate medical and surgical management can improve outcomes.
Purpose:
Pulmonary rehabilitation (PR) including exercise training improves muscle strength, exercise capacity, and health-related quality of life in patients with chronic obstructive pulmonary ...disease (COPD). However, the evidence of the effect of upper limb exercise training (ULET) on activities of daily living (ADL) is sparse. This study investigated the effect of two different types of ULET on ADL in addition to standard PR.
Methods:
Patients were randomly assigned to a strength or a combined ULET group. Both groups exercised 2 d/wk for 12 wk. Outcome measures were handgrip strength and muscle strength of biceps and triceps muscles. Moreover, health-related quality of life was assessed through the COPD assessment test (CAT) and Saint George Respiratory Questionnaire. Ability to perform ADL was evaluated through an ADL simulation test. Dyspnea was evaluated by a modified Medical Research Council scale, whereas dyspnea and fatigue perception during strength and ADL tests were measured through a modified Borg scale.
Results:
Thirty-six patients with COPD (67.4 ± 5.3 yr) participated in the study. Significant improvements in upper limb strength and CAT were found within both groups. At the end of the study period, patients in the combined group improved time of the ADL test (
P
= .02) with reduced perception of fatigue (
P
= .03) compared with patients in the strength group.
Conclusions:
In addition to standard PR of patients with COPD, the combined endurance and resistance ULET program improved ADL and muscle strength, whereas resistance training only increased strength.
The purpose of this study was to investigate the intra-rater reliability and agreement of handgrip strength (HGS) measurement using a hydraulic hand dynamometer in patients with chronic obstructive ...pulmonary disease (COPD). A sample of 19 COPD patients (18 males and 1 female; mean ± SD age, 66.9 ± 6.3 years) was evaluated using a hand dynamometer by the same rater in two different testing sessions with a 7-d interval. During each session, patients were asked to exert three maximal isometric contractions on the dominant hand and the mean value of the 3 efforts (measured in kilogram-force Kgf) was used for data analysis. The intraclass correlation coefficient (ICC
2,1
), the standard error of measurement (SEM), the minimal detectable change (MDC), and Bland-Altman methods were used to estimate the degree of test-retest reliability and the measurement error, respectively. HGS in COPD patients revealed an ICC
2,1
score of 0.99, suggesting excellent test-retest reliability. The calculated SEM was relatively small (0.59 Kgf), and the MDC presented a clinically acceptable value of 1.64 Kgf. These findings, in conjunction with the narrow width of the 95% limits of agreements (95% limits of agreement, −2.5-2.1 Kgf) in the Bland-Altman plot, reflected the measurement precision and the narrow variation of the differences during the 2 testing sessions. The results of this study demonstrated an excellent test-retest reliability of HGS measurement, indicating that this method is reliable for repeated monitoring of peripheral muscle strength in patients with COPD.
Several epidemiological studies have demonstrated that Obstructive Sleep Apnea (OSA) is a highly prevalent disorder in the general population and increases over time all over the world. The high ...prevalence is in part due to increasing rates of obesity. However, estimates of OSA prevalence in Southern Europe are generally lacking.
The aim of our study was to predict the risk of OSA in the general population of Cyprus, the southeast part of Europe, by using a dedicated questionnaire like STOP-Bang.
We screened 5736 sample housing units for eligible adults and a total population of 4118 eligible responders completed the STOP-Bang questionnaire. Participants were all adults, age 18 + residing in Cyprus. The sample was stratified according to the last demographic report (2016) by district, rural or urban area, gender and age and the estimated sample size needed was 2000. Our survey was conducted by Computer Aided Telephone Interviewing (CATI) method. The question about Neck Circumference was removed from the final evaluation due to the uncertainty of most of the participants and the risk of bias.
From a total of 4118 participants (2252 males – 54.7%, 1862 females – 45.3%), with 46.6% over 50 years old, 2641 (64.1%) were at low risk for OSA (0–2 positive answers), 1200 (29.1%) at intermediate risk (3–4 positive answers) and 277 (6.7%) at high risk (≥5 positive answers). In sum, 29.9% responded positively for snoring, 39.3% for feeling tired or sleepy during the day, 12.3% for observed apnea during sleep, and 24.6% for having or being treated for hypertension. Class II and III obesity with Body Mass Index (BMI) > 35 kgr/m2 was observed in 192 subjects (4.7%). In the subpopulation of obese participants (BMI>30 kg/m2), intermediate to high risk of OSA was present in 45%, whereas in obesity class II and III the percentage reached almost 90%.
Our survey yielded that the prevalence of intermediate to high risk for OSA was 50% in males and 18% in females, in the general population of Cyprus. These findings were similar to previously reported high OSA prevalence worldwide, considering the fact that a single questionnaire is only a screening tool and cannot alone diagnose sleep apnea.
•More than 1/3 of our population was categorized as intermediate to high risk of OSA.•The risk was higher within the 51–70 years old age group, for males, and in participants with higher BMI.•Women aged under 30 y (17.8%) and > 40 y (16.9%), reported snoring more often than women between 30 and 40 y (9.3%).•The most common symptoms of apnea tend to increase progressively over the age of 60 y and decrease later in life.•There were no significant differences between rural and urban populations in Cyprus concerning OSA symptoms.
Rifapentine, a synthetic derivate of rifampicin which was developed in 1965, has interesting pharmacological properties, including a long terminal half-life (13 h, compared to 2-3 h for rifampicin) ...and promising bactericidal activity against Mycobacterium tuberculosis. Despite being approved in 1998 by the US Food and Drug Administration (FDA) for the treatment of pulmonary tuberculosis, its global use has been limited by unavailability. In the past decade, new evidence has emerged to define rifapentine as a key component for treatment of active disease and latent infection with M. tuberculosis (LTBI).
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