Mohamed Metwally

Peripheral neuropathy in chronic obstructive pulmonary disease

Introduction Peripheral neuropathy in chronic obstructive pulmonary disease (COPD) has received scanty attention. The purpose of this study was to evaluate objectively the functional changes in the peripheral nervous system in COPD by different electrophysiological parameters and to determine the frequencies of these changes in patients with COPD. Aim Assessment of peripheral nerve conduction by evaluation of the motor and sensory nerve conduction (SNC) in COPD patients. Patients and methods In this case–control study, we recruited 25 COPD patients and matched 25 healthy controls. Motor and SNC studies for ulnar and median nerves were evaluated by means of electrophysiological nerve study. Motor nerve conduction velocity and sensory nerve conduction velocity (SNCV), distal latencies (DLs), and amplitude of compound motor action potential were recorded. Arterial blood gases including partial pressure of oxygen and carbon dioxide (PaO2and PaCO2), oxygen saturation (SaO2), and arterial pH were measured. Pulmonary function test was done and forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio were measured. Results There was a significant difference between COPD patients and the control group in all spirometric and gasometric parameters recorded, except for the arterial pH. On studying motor nerve conduction through median and ulnar nerves, there was an increase in DL, decrease in motor nerve conduction velocity, and longer F-wave latency in the COPD group than in the control group in both nerves. SNC study of the median nerve revealed a decrease in SNCV and an increase in DL in the COPD group than in the control group. Median nerve motor neuropathy was proved in 28% of patients, ulnar nerve motor neuropathy was proved in 36% of patients, whereas sensory nerve study of median nerve proved that 68% of patients have sensory axonal neuropathy and 12% have demyelinating sensory neuropathy. Median nerve Distal Latency (DL) shows negative correlation with FEV1and FEV1/FVC ratio. SNCV of the median nerve was positively correlated to oxygen tension level. Conclusion The incidence of neuropathy is high. The rate of axonal neuropathy was significantly higher than other types. Our study showed a significant positive correlation between the degree of hypoxemia and severity of neuropathy, whereas it showed negative correlation between spirometry parameters (FEV1and FEV1/FVC ratio) and median nerve DL.

Cognitive dysfunction in chronic obstructive pulmonary disease

Background Chronic obstructive pulmonary disease (COPD) is an increasingly common disease among older adults that has been linked to other comorbid conditions with serious morbidity and mortality, including cognition impairment. However, it remains poorly understood in COPD. The aim of the study The aim of this study is to evaluate cognitive dysfunction in COPD and to relate it to the severity obtained from spirometric and gasometric evaluation of COPD patients. Patients and methods In this case–control study design, 25 COPD patients and 25 age-matched and sex-matched healthy control patients were compared. Wechsler Adult Intelligence Scale-III (WAIS-III) and Mini-Mental State Examination (MMSE) were used to evaluate cognition in COPD patients. Results There was significant impairment of MMSE with a cognitive dysfunction reported in 72% of the COPD group. There was significant impairment in all components of WAIS-III, namely the verbal IQ, performance IQ, total scale IQ, and deterioration index in the COPD group than in the control group.WAIS-III scale was positively correlated to both oxygen tension and saturation, denoting the utmost role of hypoxemia in the pathogenesis of cognitive dysfunction in COPD patients. Receiver operator characteristics curves were plotted for the use of both oxygen tension and saturation, denoting good use of oxygen tension and saturation as a predictive value for impairment of MMSE and WAIS-III scale and hence cognitive dysfunction. Results Cognitive dysfunction is a fixed finding that occurs in the course of COPD. Hypoxemia seems to play the principal role in cognitive disorders. Spirometric parameters seem to be closely related to the progression and prediction of the course of those disorders.