The Global Body Examination (GBE). A useful instrument for evaluation of respiration.

Adv Physiother. 2012 Dec;14(4):146-154

Authors: Friis S, Kvåle A, Opjordsmoen S, Bunkan BH

Abstract
BACKGROUND AND AIMS: Assessment of respiration is important in medicine and physical therapy. As respiration is multifaceted, we need several specific examination methods. The purpose of this study was to develop a method for examination of visible respiratory movements, by extracting from two examinations the items with best ability to discriminate among healthy controls, patients with pain disorders and patients with psychotic disorders. METHODS: Two physiotherapists independently examined 132 individuals (34 healthy persons, 32 with localized pain, 32 with widespread pain and 34 with psychoses). Items were assigned to subscales by explorative factor analysis. Internal consistency of subscales was examined with Cronbach's alpha. To examine validity, one-way analysis of variance and the area under the curve (AUC) were used. RESULTS: WE IDENTIFIED FOUR SUBSCALES: Tension, Position of Thorax, Basal respiration and Thoracic movements. Cronbach's alpha ranged from 0.75 to 0.86. The subscales' discriminating ability was excellent between healthy controls and patients, and fair between patients with localized pain and the two other patient groups. CONCLUSIONS: The respiration domain of the new Global Body Examination has 21 items, which comprise four subscales with high internal consistency and good ability to discriminate between healthy persons and patients with pain disorders or psychosis.

PMID: 23243389 [PubMed - as supplied by publisher]

Nasal allergies in the Middle Eastern population: Results from the "Allergies in Middle East Survey".

Am J Rhinol Allergy. 2012 Nov-Dec;26(6 Suppl 1):3-23

Authors: Abdulrahman H, Hadi U, Tarraf H, Gharagozlou M, Kamel M, Soliman A, Hamad WA, Hanna KM, Mostafa BE, Omrani M, Abdelmotal A, Moukarzel N

Abstract
BACKGROUND: Chronic respiratory diseases such as asthma and allergic rhinitis (AR) are a major public health problem in developing countries including those in the Middle East. However, to date, there is a paucity of information related to physician-diagnosed AR in this region. The Allergies in Middle East Survey was undertaken to help clarify and broaden the understanding of physician-diagnosed AR across Egypt, Iran, Lebanon, Saudi Arabia, and the United Arab Emirates. The survey explores the frequency of physician-diagnosed AR, prevalence and types of associated symptoms, the impact on quality of life (QOL), current treatment practices, and therapy expectations.
METHODS: In total, 7411 households in five countries (Egypt, Lebanon, Saudi Arabia, Iran and the United Arab Emirates) were screened to identify individuals that were ≥4 years old with a physician diagnosis of AR and either symptoms and/or treatment in the past 12 months. A total of 501 respondents from the five countries completed the survey. Standardized questionnaires were used to make comparisons across the regions; however, the data collection procedures were tailored for each country. The sample was probability based to ensure valid statistical inference to the population.
RESULTS: Ten percent of the Middle East population surveyed had a physician diagnosis of AR, with 65% of respondents stating that their allergies were intermittent in nature. An otolaryngologist or allergist diagnosed the majority of the individuals surveyed. Runny nose, nasal and throat itching, postnasal drip, and nasal congestion or stuffed up nose were the most common and bothersome symptoms of AR. The majority of survey participants (58% of the overall survey population) with AR reported that the condition had an impact on their daily private and professional life. Seventy-two percent of adults reported that their AR symptoms limited their work/school activities and 35% reported that their AR interfered with and caused them to miss work or school within the past 12 months. One factor, in addition to the outward AR symptoms, that could have contributed to these function impairments may have been sleep disturbances. Although a secondary symptom to AR, sleep disturbances (difficulty getting to sleep, waking up during the night or lack of a good night's sleep) were shown in this survey to be extremely troubling in ∼15% of AR sufferers. In the past year >90% of patients reported taking a medication of any type for their AR, with nearly a 4:1 ratio of patients taking a prescription medication versus an over-the-counter (OTC) medication in the past 4 weeks. Over 75% of survey respondents reported taking an intranasal corticosteroid (INCS) in the last 4 weeks and the satisfaction rate of INCS medications was similar to that reported for OTC medications. The most common reasons cited for dissatisfaction with INCS medications were inadequate effectiveness, bothersome side effects (e.g., unpleasant taste and retrograde drainage into the pharynx), decreased effectiveness with chronic use, and failure to provide 24-hour relief.
CONCLUSION: These data show that AR is common in the Middle East region as elsewhere in the world. Many patients with AR in Middle East region suffer from their symptoms (e.g., runny nose, nasal itching, nasal congestion, postnasal drip, and other symptoms) on all or most days during the times of the year that their allergies are worst. These symptoms have been shown to reduce QOL and performance at work/school to a significant degree. Additionally, the survey data underscore a considerable treatment gap with current therapies for AR and that many AR patients still have not found adequate effectiveness with currently available medications. Thus, through identification of disease impact on the Middle East population and highlighting treatment gaps, clinicians in the Middle East may better understand and treat AR, leading to improvements in overall patient satisfaction and QOL.

PMID: 23232281 [PubMed - in process]

Biochemical pathogenesis of aspirin exacerbated respiratory disease (AERD).

Clin Biochem. 2012 Dec 12;

Authors: Narayanankutty A, Reséndiz-Hernández JM, Falfán-Valencia R, Terán LM

Abstract
Aspirin exacerbated respiratory disease (AERD) is a distinct clinical entity characterized by eosinophilic rhinosinusitis, asthma and often nasal polyposis. Exposure to aspirin or other nonsteroid anti-inflammatory drugs (NSAIDs) exacerbate bronchospasms with asthma and rhinitis. Disease progression suggests a skewing towards TH2 type cellular response along with moderate to severe eosinophil and mast cell infiltration. Alterations in upper and lower airway cellular milieu with abnormalities in eicosanoid metabolism and altered eicosanoid receptor expression are the key features underlying AERD pathogenesis. Dysregulation of arachidonic acid (AA) metabolism, notably reduced prostaglandin E(2) (PGE(2)) synthesis compared to their aspirin tolerant counterpart and relatively increased PGD(2) production, a TH2/eosinophil chemoattractant are reported in AERD. Underproduced PGE(2) is metabolized by overexpression of 15 prostaglandin dehydrogenase (15-PGDH) to inactive products further reducing PGE(2) at real time. This relive the inhibitory effect of PGE(2) on 5-lipoxygenase (5-LOX) resulting in overproduction of cysteinyl leukotrienes (CysLTs). Diminished formation of CysLT antagonists called lipoxins (LXs) also augments CysLTs responsiveness. Occasional intake of NSAIDs favors even more 5-LOX products formation, further narrowing the bronchoconstrictive bottle neck, resulting in acute asthmatic exacerbations along with increased mucus production. This review focuses on abnormalities in biochemical and molecular mechanisms in eicosanoid biosynthesis, eicosanoid receptor dysregulation and associated polymorphisms with special reference to arachidonic acid metabolism in AERD.

PMID: 23246457 [PubMed - as supplied by publisher]

Mimics in chest disease: interstitial opacities.

Insights Imaging. 2012 Dec 18;

Authors: Oikonomou A, Prassopoulos P

Abstract
Septal, reticular, nodular, reticulonodular, ground-glass, crazy paving, cystic, ground-glass with reticular, cystic with ground-glass, decreased and mosaic attenuation pattern characterise interstitial lung diseases on high-resolution computed tomography (HRCT). Occasionally different entities mimic each other, either because they share identical HRCT findings or because of superimposition of patterns. Idiopathic pulmonary fibrosis (IPF), fibrosis associated with connective tissue disease, asbestosis, end-stage sarcoidosis or chronic hypersensitivity pneumonitis (HP) may present with lower zone, subpleural reticular pattern associated with honeycombing. Lymphangiomyomatosis may be indistinguishable from histiocytosis or extensive emphysema. Both pulmonary oedema and lymphangitic carcinomatosis may be characterised by septal pattern resulting from thickened interlobular septa. Ill-defined centrilobular nodular pattern may be identically present in HP and respiratory bronchiolitis-associated with interstitial lung disease (RBILD). Sarcoidosis may mimic miliary tuberculosis or haematogenous metastases presenting with miliary pattern, while endobronchial spread of tuberculosis may be indistinguishable from panbronchiolitis, both presenting with tree-in-bud pattern. Atypical infection presenting with ground-glass mimics haemorrhage. Ground-glass pattern with minimal reticulation is seen in desquamative interstitial pneumonia (DIP), RBILD and non-specific interstitial pneumonia (NSIP). Obliterative bronchiolitis and panlobular emphysema may present with decreased attenuation pattern, while obliterative bronchiolitis, chronic pulmonary embolism and HP may manifest with mosaic attenuation pattern. Various mimics in interstitial lung diseases exist. Differential diagnosis is narrowed based on integration of predominant HRCT pattern and clinical history. Teaching Points • To learn about the different HRCT patterns, which are related to interstitial lung diseases. • To be familiar with the more "classical" entities presenting with each HRCT pattern. • To discuss possible overlap of different HRCT patterns and the more common mimics in each case. • To learn about some clues that help differentiate the various diagnostic mimics on HRCT.

PMID: 23247773 [PubMed - as supplied by publisher]