Efficacy of Erb-Laser on Inferior Turbinate Hypertrophy: A Retrospective and Cohort Study.

Objectives: Nasal obstruction (NO) is a very common complaint in the practice of otolaryngology. The cause of NO can be due to inferior turbinate hypertrophy (ITH), which may be a result of allergic rhinitis, hyperreactivity, hormonal causes, rhinitis medicamentosa or idiopathic. The most commonly used treatments today include local nasal or systemic corticosteroids, cauterization or microdebrider, or thermal ablation with radiofrequency, coblation or ablative laser (mainly carbon dioxide or diode lasers), and submucosal reduction. Erbium YAG laser in non-ablative and SMOOTH thermal mode is considered as a non-invasive treatment and could be a novel and safe alternative.The aim of this study was to evaluate the safety and performance of a new Erb-laser treatment protocol on bilateral ITH, during and after 3 sessions of treatment throughout 6 months. Methods: This retrospective study was carried out over 30 patients with complaints of NO, sneezing, itching, discharge, and nasal congestion refractory to medical management from July 2019 to December 2020 in the Department of Otorhinolaryngology of a private hospital in Famagusta, North Cyprus. Symptoms were evaluated subjectively by using NO Score and Visual Analog Scale (VAS). Patients were evaluated at the post-procedural 1st-week, and 1st-, 3rd-, and 6th-month postoperatively. During each follow-up visit, symptoms were reassessed by VAS and NO Score. Results: Differences between pre-operative and post-operative VAS and NO Scores were statistically significant. All patients had significant symptomatic improvements, which started from the post-operative 1stweek and persisted throughout the follow-up period. The active laser treatment showed high improvement during and after the procedure, regarding NO, and decreased the nasal burden on quality of life. Conclusion: Erbium YAG laser treatment is a simple, safe, effective, and non-invasive method effective on ITH, with minimal damage on the nasal mucosa. It can be done as an office procedure, with minimal complications. This method will provide a great advantage in the future treatment of NO.

Evaluation of musculoskeletal pain and related factors in school-age children (8-12 years).

OBJECTIVES: The aim of this study was to evaluate the frequency of pain and related factors in musculoskeletal system in children. METHODS: A total of 313 primary school students were analyzed in this cross-sectional study conducted in the Famagusta city center and surrounding villages. The physical activity musculoskeletal pain (MSP) level, health-related quality of life weight, height, and school bag weights of the students were measured by a blinded researcher. RESULTS: The study group consisted of 164 (52.40%) boys and 149 (47.6%) girls with a mean age of 9.53±0.82 years. In the present study, MSP frequency was found to be 39.0%. There was no relationship between MSP and the following parameters: Age, sex, body mass index, hours of weekly gym lesson, regular participation in sports, weekly time spent with sports, school bag type, and school bag weight. There was also no relationship between these parameters and region of pain. CONCLUSION: Excessive walking and sitting were associated with increased MSP. Contrary to popular opinion, it was found that school bag weight and school bag type were not effective on MSP. Our results show that the quality of life of children can be improved by reducing MSP.

Treatment Analysis of Patients Followed up With Postherpetic Neuralgia in Nothern Cyprus.

Background: Postherpetic neuralgia (PHN) is a frequent complication of herpes zoster (HZ). Treatment of this chronic pain syndrome and results are often not clear. Tricyclic antidepressants, gabapentinoids and potent opioids are first-line treatments and are highly effective, but their use is limited due to adverse effects that may occur in elderly patients with significant medical comorbidities or interaction due to multiple drug use. There are no head-to-head comparisons of non medical treatments. Dry needling appears comparable to conventional physical therapy for treating PHN. Objective: Our aim is to determine the incidence of PHN in our population and to compare the treatments in patients with postherpetic neuralgia. Methods: A search for HZ and PHN was conducted in a general practice research database, comprising 2 general practices (dermatologist and physiatrist) and representing 5600 people. We analyzed a retrospective 37 case with PNH of 170 herpes zoster patient admmited to the dermatology and physical therapy and rehabilitation outpatient clinic between October 2018 and October 2020. Dry needling and physical therapy methods applied in addition to medical treatment in PHN treatment were compared. Results: In patients with postherpetic neuralgia, both dry needling therapy group and physical therapy group LANSS scores decreased significantly in the first week and in the third week compared to baseline. Dry needling therapy group has also similar results in VAS scores in the first and third week. But in physical therapy group, the VAS score did not show a significant decrease in the first week compared to the baseline, but it decreased significantly in the third week. Conclusion: PHN is a complex, difficult to treat and severe neuropathic pain that affects patients' daily function and quality of life. Various agents and methods are available to relieve the symptoms of PHN. This study shows as both physical therapy and dry needling therapy are effective treatment for postherpetic nevralgia..

Report on 25 Notalgia paresthetica cases: Clinical features and treatments.

OBJECTIVES: Notalgia paresthetica (NP) is a neuropathic condition that manifests as a chronic itch on the back. The aim of this retrospective study was to examine the characteristics of patients diagnosed with NP. METHODS: A total of 25 female patients, aged 26-64 years (mean+-10.67 years; median 47.17 years), were studied to determine the spinal or peripheral origin of NP. RESULTS: On radiological examination, discopathy was observed in 24% of the patients, arthrosis in 32%, and degeneration in 56%. There was no significant relationship found between dermatological symptoms and magnetic resonance imaging posi-tivity (p=0.188). The patients' treatment programs were based on either physical therapy (44%), local injection (28%), exercise therapy (16%), or physical therapy and kinesiotherapy (12%). Subjective measures for pain were validated with an average visual analog scale (VAS), and the 'Douleur Neuropathique 4' (DN4) questionnaire was used to screen for neuropathic pain. The VAS score of the patients before treatment was 7, and after treatment was 2. The mean DN4 score was 7 before treatment and 2 after treatment. CONCLUSION: NP is a rare syndrome of unknown etiology. We aim in this study to analyse NP clinical properties and treatment.

Two Sisters with Mal de Meleda: Case Series Report.

Mal de Meleda (MDM) is a rare autosomal recessive type of palmoplantar keratoderma that is characterized by transgradient keratoderma with scleroatrophy, pseudoainhum around the fingers, and perioral erythema. Its features may also include lichenoid lesions, brachydactyly, and nail dystrophy. The disease has high morbidity and significantly impairs quality of life. Here, we describe two sisters with typical clinical presentations of MDM and a history of consanguinity between the parents.

Comparison the Effects of Physical Therapy on Chronic Pain in Active or Sedentary Military Personnel.

BACKGROUND: Chronic pain (CP) is a debilitating condition in which pain persists for months or years beyond the expected duration seen in normal healing processes. Because of the social and economic burden of CP in military personnel, it is important to ascertain pain-related physical, mental and psychological conditions to improve pain management. OBJECTIVE: The aim of the study was to evaluate the effectiveness of the physical therapy in active military personnel (AMP) with CP through self-reported questionnaires. METHODS: Sixty male AMP outpatients suffering from CP were included and divided into two groups according to their exercise levels in daily life (30 patients exercised regularly, while the remaining 30 had a sedentary lifestyle). All participants completed the following forms and questionnaires: Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) for pain, Neck Disability Index (NDI), Neck Bournemouth Questionnaire (NBQ), International Physical Activity Questionnaire (IPAQ), Hospital Anxiety-Depression Index (HADS), 36-item Short Form Survey (SF-36), Automatic Thoughts Questionnaire (ATQ), and Pain Belief Questionnaire (PBQ). Patients were given 10 sessions of a standardized physical therapy program, including hot pack applications, TENS, ultrasound therapy and also home-based physical exercise. RESULTS: The median age of patients was 22 (min-max: 20-42) years. The HADS and PBQ-psychological scores were high and ATQ scores were low in both groups. After the treatment, ODI and VAS scores decreased in both groups; however, the group comprised of patients that exercised regularly at baseline also demonstrated a significant decrease in NBQ and NDI values. CONCLUSION: We showed that three components of pain (physical, cognitive and emotional) are indeed effective on pain intensity and levels of disability. Our study showed that scales related with pain could improve by physical therapy in AMP, and that patients who normally exercised benefitted from physical therapy at a relatively higher degree. Chronic pain needs to be managed in the context of the patient's biological, psychological, social and also occupational characteristics; thus, individualized, patient-specific and multi-factorial treatments should be considered whenever possible.

The Effect of Short-Wave Diathermy and Exercise on Depressive Affect in Chronic Low Back Pain Patients.

OBJECTIVE: The aim of this study was to compare exercise, continuous short-wave diathermy (SWD) and intermittent SWD treatment modalities and to evaluate the effects of these treatments on chronic back pain and depression. METHODS: This study is an intervention trial which evaluated patients who applied to our clinic due to chronic low back pain between 2008-2009. The study group consisted of 90 patients between the ages of 40-65 who had had low back pain for more than 6 months. The patients were randomized into three groups. The first group received placebo short-wave diathermy, the second group received continuous short-wave diathermy, and the third group received pulsed short-wave diathermy. Pain was evaluated by Visual Analog Scale (VAS) and the Pain Disability Index (PDI).The Modified Oswestry Low Back Pain Disability Questionnaire Form was used for the measurement of functional deficiency and the Beck Depression Inventory (BDI) was used for the evaluation of depression.All scales were performed before the treatment, immediately after treatment and 3 months after treatment. RESULTS: Significant decreases in PDI and VAS scores were found in all groups (p<0.05 for each). Similarly, there was a significant improvement in all groups in terms of functional deficiency(p<0.001 for each), while no differences were found between groups (p = 0.895). In terms of BDI scores, there was no improvement in those receiving only exercise, while Group 2 and 3 had significant improvements (p <0.05). When groups were compared for BDI scores, no differences were found between any of the groups (p = 0.189). CONCLUSION: Continuous SWD treatment with exercise was found to be more effective in reducing pain in patients with chronic low back pain than other treatment modalities used in our study. Although there was no significant difference between the groups in terms of depressive mood, it was found that those receiving continuous and pulsed SWD treatment had significant improvements in depression as measured by the BDI.

Venous Lakes of the Lips Successfully Treated With a Sclerosing Agent 1% polidocanol: analysis of 25 report cases.

BACKGROUND: Venous lakes of the lip is vascular ectasia that generally appears on the lower lip and other sun-damaged surfaces of skin in elderly patient. There are many local therapies for treatment of lip venous lake such as surgical excision, cryotherapy, infrared coagulation and laser therapy. Sclerotherapy as treatment is used in varicose veins, leg telangiectasia, hemorrhoids and hemangiomas but for lip venous lake only two case has been reported. Therefore, we managed this study to determine the efficacy of injection of 1% polidocanol in the treatment of venous lake lesions. METHODS: This is retrospective study. Twenty five adult patient presenting with several localizations of venous lake were enrolled in the study. Informed consent was given before the treatment and a photo of the venous lake was taken. After the lesion was cleaned with an antiseptic, was slowly injected 1% polidocanol into each patient's lesion, followed by compression for 5 min. Visual Analog Scale (VAS) scale was used to indicate patient satisfaction. RESULT: Lesions were completely cleared in all patients after treatment. The lesions generally disappeared in two cases leaving an insignificant scar, in two cases become angioedema with two sessions of sclerotherapy. In other cases side effects were not observed. CONCLUSION: Sclerotherapy with polidocanol is an easy, inexpensive method and is found very effective in the treatment of lip venous lake. In the future it offers an alternative to other classic methods.

The Effect of Personal Protective Equipment (PPE) and Disinfectants on Skin Health During Covid 19 Pandemia.

BACKGROUND: Based on the available evidence, the COVID-19 virus is transmitted through close contact and droplets, not in the form of airborne transmission (airborne) among humans. People at risk of infection are those who are in close contact with or looking after COVID-19 patients. Preventive and mitigation measures are key in both the healthcare sector and the community. Personal protective equipment (PPE) is mandatory to protect healthcare workers from the new coronavirus, but healthcare workers may have skin damage especially associated with long-term use of PPE. OBJECTIVE: The main purpose in this study is to forward the effects of PPE and disinfectants on health care workers skin health. METHODS: From March to May 2020, self-administered face to face questionnaires were distributed to 200 individuals, consisting of healthcare workes who served in the designated departments of tertiary hospitals Famagusta /Cyprus. The questionnaire included questions about the condition of skin damage and the frequency or duration of several infection-prevention measures. RESULTS: The most common protection equipment were surgery mask (91.5%), gloves (87.5%) and hand sanitizer (52.0%). In addition, 141 (70.5%) individuals stated take a bath/shower frequently as a protection method from COVID and135 (67.5%) individuals stated air conditioning. Most individuals use latex gloves with powder (65.0%) or powder free (62.0%). Mean daily duration of wearing mask was 7.32 ± 4.54 (range 0-24) hours, wearing visor or glasses was 3.16 ± 3.97 (range 0-24) hours, wearing protective apron was 4.20 ± 4.57 (range 0-24) hours and wearing gloves was 5.33 ± 4.03 (range 0-24) hours. Eighty (40.0%) individuals bought personal protective equipment for COVID. Most individuals (73.0%) did not see a COVID patient while 18 (9.0%) individuals sampled from a COVID patient. None of the individuals was COVID positive. Mean stress level was 70.24 ± 23.58 (range 0-100). Most individuals (92.0%) stay at home except working times. Fifty-two (26.0%) individuals had hand dryness (xerosis cutis), 38 (19.0%) individuals had body itching or exanthema, 41 (20.5%) individuals had facial wounds because of mask, visor etc. and 68 (34.0%) individuals had rhinitis. Twenty-nine (14.5%) individuals had treatment because of dermal problems. CONCLUSION: Atopy, winter season, low humidity frequency of hand washing with detergents / disinfectants can disrupt the hydro-lipid cover of the skin surface and also cause irritation and even the development of contact dermatitis. Two-thirds of healthcare workers wash their hands 10 times a day, but only 22% applied skin protective cream. Also, according to a study, prophylactic dressings have been shown to alleviate pressure injuries associated with the device. Also, longer exposure time is an important risk factor. Latex-free gloves are now a mandatory standard in many hospitals and clinics and have the potential to reduce occupational skin diseases.

Norwegian scabies in a child with Down syndrome.

Crusty scabies or Norwegian scabies is a highly contagious type of scab that is characterised by intense infestation by Sarcoptes scabiei in the skin and widespread, crusty, hyperkeratotic papules, plaques and nodules. The infection can be missed due to its atypical appearance. Patients with cognitive impairment or an immunodeficiency disorder (including immunosuppressive therapy) are prone to developing crusty scabies. Although the relationship between Down syndrome and crusted scabies is explained as an absence of effective immune system, it is still not fully understood. In this communication we report a 28-month-old girl with Down syndrome who presented with crusted scabies.

Chronic Pain and Pain Belief in Active Military Personnel: a Cross-sectional Study.

BACKGROUND: Chronic pain (CP) and mental disorders are common among active military personnel (AMP) due to their potential exposure to various physical and psychological stressors. AIM: The aim of this study was to evaluate pain perception and beliefs regarding their pain among AMP suffering from CP using self-reported measures, and to understand the development and persistence of pain in AMP. METHODS: Sixty male AMP outpatients suffering CP were included. All participants completed the following forms and questionnaires: Oswestry Disability Index(ODI), Visual Analogue Scale(VAS), Neck Disability Index(NDI), Bournemouth Questionnaire for neck(BQN), International Physical Activity Questionnaire(IPAQ), Hospital Anxiety and Depression Index(HADS), 36-item Short Form Survey(SF-36), Automatic Thoughts Questionnaire(ATQ), and Pain Belief Questionnaire(PBQ). RESULTS: The mean age of the participants was 22.85±3.50 years, the median duration and frequency of pain were 12 months and 14.5 days in a month, respectively. The median of ODI scores was 26; three of patients were evaluated as crippled while 8 patients had severe disability. The HADS and PBQ-psychological scores were high in the patient group. Positive correlations were found between pain frequency and the ODI, VAS, NDI and PBQ-psychological scores. Relationships were also shown between PBQ-psychological and the VAS and ATQ scores. Correlations between ODI scores and ATQ scores were also revealed. CONCLUSIONS: Our results suggest that, in addition to the organic basis of pain, there is strong evidence for significant contribution from the psychological characteristics and pain-related beliefs of the patients. Physicians may choose a multi-dimensional perspective in the diagnosis and treatment of pain, especially in patients suffering from CP.

Poor Sleep Quality I Related to Impaired Functional Status Following Stroke.

INTRODUCTION: Sleep disorders are more prevalent in patients with previous stroke compared to healthy individuals. The main objective of the present study was to investigate the impact of sleep quality on the functional status of patients with a history of stroke, upon admission to inpatient rehabilitation. METHODS: Fifty patients (mean age: 69 ± 11 years) with previous stroke were consecutively included in this single center cross-sectional observational study upon admission to inpatient rehabilitation. Pittsburgh Sleep Questionnaire Index (PSQI) was calculated for all patients and patients were divided into 2 groups according to PSQI scores (PSQI ≤ 5 as good sleepers and PSQI > 5 as poor sleepers). A specialist evaluated the level of muscle spasticity and disability, walking capability, and overall performance of daily activity of all enrolled patients using the functional ambulation scale (FAS) score, modified Brunnstrom Classification, Modified Ashworth scale, and Beck Depression Inventory. RESULTS: The FAS score (3.4 ± 1.3 versus 1.8 ± 1.7, P = .004) and Brunnstrom scores of upper limb (3.8 ± 1.1 versus 2.5 ± 1.6, P = .005), lower limb (4.3 ± 1.4 versus 3.1 ± 1.7, P = .013) and hand (3.6 ± 1.5 versus 2.3 ± 1.6, P = .006) were significantly higher in good sleepers than poor sleepers. Linear regression analysis revealed that PSQI score (coefficient ß = -.360, 95% CI: -.212-.032, P = .009) and age (coefficient ß = -.291, 95% CI: .100-.245, P = .032) were independently associated with FAS score. CONCLUSION: Results of the present study indicate that presence of poor sleep quality is associated with poor functional status which might further impair the outcomes of the rehabilitation and accordingly the health-related quality of life in patients admitted for stroke rehabilitation.

Clinical and functional outcomes and proprioception after a modified accelerated rehabilitation program following anterior cruciate ligament reconstruction with patellar tendon autograft.

OBJECTIVES: The aim of this study was to evaluate the clinical and functional outcomes and proprioceptive function in patients who received a modified accelerated rehabilitation program after anterior cruciate ligament (ACL) reconstruction with a patellar tendon (PT) graft. METHODS: The study included 38 patients (33 men, 5 women; mean age 27.6 ± 6.4 years; range 18 to 45 years) who underwent ACL reconstruction with a PT graft and participated in a modified accelerated rehabilitation program. Only six patients were athletes. Isokinetic strengths of concentric knee extension and flexion were measured with the Cybex isokinetic dynamometer, and static balance was tested with the Sport-KAT device. For proprioceptive assessment, active repositioning was measured at knee flexions of 40°, 20°, and 5° with an isokinetic dynamometer. Activity levels and subjective functional results were evaluated with the Tegner activity scale and Lysholm knee score, respectively. For objective functional testing, single leg hop, triple leg hop, and one-legged crossover hop tests were used. Knee stability was assessed with the Lachman test and anterior drawer test and knee range of motion was measured. The mean follow-up period was 16.2 ± 9.8 months. RESULTS: There was no graft failure during the follow-up. Twenty patients (52.6%) had hypoesthesia at the donor site and 15 patients (39.5%) had anterior knee pain. Before surgery, all the patients had positive results in the Lachman and anterior drawer tests. After surgery, the Lachman test was negative in 32 patients (84.2%), while six patients (15.8%) had grade 1 laxity. The mean Lysholm knee score showed a significant increase postoperatively (p<0.001). The mean preoperative and postoperative Tegner activity scores were not significantly different (p>0.05). There were no significant differences in the range of motion between operated and uninjured extremities (p>0.05). The two extremities were similar in proprioception and balance (p>0.05). Isokinetic quadriceps muscle strength was significantly decreased in the operated extremity only in extension at 60°/sec angular velocity (p<0.05). Other muscle strength measurements were similar in both extremities. The ratios of flexion/extension muscle strength were significantly greater in the involved extremity at all angular velocities (p<0.05). The mean performance scores of three functional tests were more than 85% of the uninvolved extremity. All the patients returned to preinjury daily activities or sports activities in 6 to 12 months postoperatively. CONCLUSION: We had satisfactory clinical, proprioceptive, and functional results in achieving dynamic and static stability of the knee with the modified accelerated rehabilitation program after ACL reconstruction with a PT graft.

Effects of muscle strengthening versus aerobic exercise program in fibromyalgia.

The purpose of this study was to compare the effects of aerobic training with a muscle-strengthening program in patients with fibromyalgia. Thirty women with fibromyalgia were randomized to either an aerobic exercise (AE) program or a strengthening exercise (SE) program for 8 weeks. Outcome measures included the intensity of fibromyalgia-related symptoms, tender point count, fitness (6-min walk distance), hospital anxiety and depression (HAD) scale, and short-form health survey (SF-36). There were significant improvements in both groups regarding pain, sleep, fatigue, tender point count, and fitness after treatment. HAD-depression scores improved significantly in both groups while no significant change occurred in HAD-anxiety scores. Bodily pain subscale of SF-36 and physical component summary improved significantly in the AE group, whereas seven subscales of SF-36, physical component summary, and mental component summary improved significantly in the SE group. When the groups were compared after treatment, there were no significant differences in pain, sleep, fatigue, tender point count, fitness, HAD scores, and SF-36 scores. AE and SE are similarly effective at improving symptoms, tender point count, fitness, depression, and quality of life in fibromyalgia.