Bone mass and vitamin D levels in Parkinson's disease: is there any difference between genders?

[Purpose] The aim of this study was to determine the bone mineral density, vitamin D level, and frequencies of osteopenia and osteoporosis in patients with Parkinson's disease and to compare male and female patients with the controls separately. [Subjects and Methods] One hundred fifteen Parkinson's disease patients (47 males, 68 females; age range: 55-85 years) and 117 age- and gender-matched controls (47 males, 70 females) were enrolled in the study. Bone mineral density measured by dual-energy X-ray absorptiometry and serum D vitamin levels of each participant were recorded. [Results] The mean lumbar spine, femur neck, and total femur bone mineral density levels, T-scores, and vitamin D levels were found to be significantly lower in Parkinson's disease patients in both genders. Furthermore, osteoporosis rates were found be significantly higher only in female Parkinson's disease patients compared with female controls. [Conclusion] Data from the present study revealed that while osteoporosis was significantly higher only in female Parkinson's disease patients, all Parkinson's disease patients had lower bone mineral density scores and vitamin D levels compared with the controls regardless of gender, suggesting that clinicians should pay attention to the osteoporosis risk in Parkinson's disease and that adequate preventive measures should be taken in order to limit the future risk due to osteoporotic fractures.

Intramuscular botulinum toxin-A in complex regional pain syndrome resistant to standard treatment: a case report.

OBJECTIVE: To present a patient with complex regional pain syndrome type 1 (CRPS-I) and improvement of contracture of hand muscles and grip strength after successful treatment with botulinum neurotoxin­A (BoNT-A). CASE: A 53-year-old woman with CRPS­I experienced severe allodynia, swelling and autonomic changes in the left hand after a distal radius fracture. Over the succeeding months, she developed contracture of the left hand muscles which was treated with injection of BoNT­A into the hand muscles (10 points). RESULTS: In the patient treatment with BoNT­A an improvement was seen in the hand range of motion (ROM) and grip strength. CONCLUSION: Successful results can be obtained with BoNT­A injection in treatment-resistant CRPS­I cases which may develop joint contracture.

Effects of low-level laser therapy on symptomatic calcific rotator cuff tendinopathy : A prospective randomized controlled study.

OBJECTIVE: Rotator cuff calcific tendinitis (RCCT) is a benign but incapacitating condition and in some patients it is the cause of chronic debilitating pain and functional disability. We aimed to reveal the short-term effects of low-level laser therapy (LLLT) on clinical and sonographic parameters in patients with symptomatic RCCT. METHOD: This prospective randomized controlled study analyzed 76 painful shoulders of 68 patients aged 18-75 years, with over 3 months of shoulder pain and where RCCT was confirmed sonographically. Patients in the LLLT group (received 5 LLLT sessions per week and home exercises for 5 days/week for 3 weeks) and the control group (received home exercises, 5 days/week for 3 weeks) were assessed clinically and sonographically just before and after treatment, recording pain intensity, range of motion (ROM), shoulder functional status, location (supraspinatus/infraspinatus, subscapularis), number and degree of calcification. Degree of calcification was determined with ultrasound and classified by the Bianchi-Martinoli classification. The LLLT was applied to the calcified areas marked under ultrasound guidance. RESULTS: Both groups showed statistically significant improvements in ROM, pain intensity, shoulder pain and disability index (SPADI) pain/disability/total, and degree of calcification after treatment. No significant change was achieved for calcification in the control group. Considering the change values, improvements in abduction, extension, pain intensity, SPADI pain/disability/total, calcification number, and calcification degree parameters were found to be statistically significantly better in the LLLT group than in the control group. CONCLUSION: Adding LLLT to the home program in treatment of symptomatic RCCT outperformed the home program alone, reducing the number and severity of calcifications, improving pain and disability.

Is there a paradoxical side effect? Is it a case of inefficiency? Peripheral ulcerative keratitis in a patient with rheumatoid arthritis in remission treated with tocilizumab.

Tocilizumab is a monoclonal antibody to interleukin-6 that has recently been used in rheumatoid arthritis (RA) treatment. Treatment with tocilizumab may be associated with paradoxical manifestations that are poorly understood. Patients that developed peripheral ulcerative keratitis while on tocilizumab treatment were studied in a case series. It was discovered that this could be a paradoxical side effect or ineffectiveness. Herein, we present a patient with seropositive RA who was followed for 22 years, using tocilizumab for seven years, and who developed peripheral ulcerative keratitis while in remission. Consequently, even in remission, extra-articular involvement can occur in RA patients, and medication-related paradoxical side effects can arise.

Pediatric Dysphagia Risk Screening Instrument (PDRSI) in Children With Cerebral Palsy.

This study aimed to evaluate whether the Pediatric Dysphagia Risk Screening Instrument (PDRSI) was a suitable test for children with cerebral palsy (CP) and assess the instrument's Turkish validity and reliability. One-hundred twenty-six children with CP participated in this study. "Cronbach's alpha (ɑ)," "Cronbach's ɑ when one item is deleted," "inter-item correlation," and "corrected item-to-total correlation" were used to assess internal consistency. In addition, inter-rater agreement tests (Cohen's kappa coefficient) were conducted for reliability. Construct validity was used to assess the validity. Moreover, flexible fiberoptic endoscopic evaluation of the swallowing method was used to describe the receiver operating characteristic curve analysis and calculate the sensitivity and specificity of T-PDRSI. It was found that the PDRSI had adequate validity and reliability. The PDRSI can be used in children with CP as a valid and reliable instrument with high sensitivity and specificity.

Factors influencing the willingness to participate in rehabilitation in patients with subacute stroke.

OBJECTIVE: The aim of this study was to examine the parameters that may influence the willingness of patients to participate in post-stroke rehabilitation. METHODS: Patients in the subacute phase of stroke who underwent inpatient rehabilitation for one month were included in this study. The primary outcome measure was the level of rehabilitation participation as measured on the Pittsburgh Rehabilitation Participation Scale (PRPS). Other outcome measures evaluated were Mini-Mental State Examination (MMSE) for cognitive functions, Brunnstrom stage for motor recovery, modified Rankin Scale (mRS) for disability, Functional Independence Measure for functionality, Pittsburgh Sleep Quality Index for sleep quality, and Beck Depression Inventory for emotional state. RESULTS: A total of 38 patients with first-time stroke were studied. A negative correlation was found between the participation in rehabilitation and body mass index (BMI) (r: -0.398p = 0.012), myocardial infarction (MI) history (r: -0.387p = 0.015) and mRS (r: -0.351p = 0.031), while a positive correlation was determined with MMSE (r: 0.432P = 0.007). A 1-unit increase in BMI, MI history, and mRS resulted in a 0.176, 0.673, and 0.294-unit decrease in participation in rehabilitation, respectively. In addition, a 1-unit increase in MMSE provided an increase of 0.606-unit in participation. CONCLUSION: BMI within normal limits, prevention/treatment of cardiovascular diseases, and well-being of physical and cognitive functions might be the factors that positively influence participation in rehabilitation process. We consider that it would be appropriate to evaluate these parameters with particular emphasis in stroke patients in the subacute period to be rehabilitated.

Depression and Somatization in Refractory Lateral Epicondylitis.

OBJECTIVES: This study aims to present two major psychological factors, namely depression and somatization, which may occur with high probability in patients with refractory lateral epicondylitis (LE). PATIENTS AND METHODS: This cross-sectional study included 36 patients (11 males, 25 females; mean age 42.6±8.09 years; range 26 to 60 years) diagnosed as refractory LE. Duration of symptoms was >6 months. Each patient completed the Beck Depression Inventory and the Symptom Checklist-90-Revised test evaluating psychosocial status and somatization, respectively. RESULTS: Depression was found in 24 (66.6%) (moderate in 15 [41.7%] and mild in 9 [25%]) and somatization was found in 28 (77.8%) patients. Depression and somatization were significantly more common in females than males (p=0.02 and p=0.04, respectively). CONCLUSION: Depression and somatization may occur frequently in refractory LE patients, particularly in females. Both physical and psychological assessment tools should be incorporated into the clinical evaluation while psychological support should be included in the treatment of refractory LE.

A Rarely Seen Complication That Causes Increase in Morbidity in Tetraplegic Patients: Zenker Diverticula.

Although spinal cord injury (SCI) damages the spinal cord, physiological changes due to SCI can affect many organs and systems of the human body. While respiratory problems are common following cervical SCI, dysphagia is a relatively uncommon secondary complication that occurs after cervical SCI. We report a case of recurrent aspiration pneumonia due to Zenker diverticulum in 26-year-old tetraplegic patient with a chronic history of silent aspirations and dysphagia contributing to functional disability.