Restless legs syndrome in patients with chronic low back pain.

Background: Based on studies showing that both chronic low back pain (LBP) and restless legs syndrome (RLS) have similar pathophysiological mechanisms, we aimed to investigate the prevalence of RLS in patients with chronic LBP and to define which demographic and clinical features are prominent in those with LBP accompanied by RLS. Methods: One hundred and two eligible, volunteer participants with chronic LBP were enrolled in this study. Visual analog scale (VAS), the Oswestry Disability Index (ODI), Pittsburgh Sleep Quality Index, Beck Depression Inventory, and Short Form-36 scales were applied to the patients. All patients were evaluated face-to-face for RLS using the International RLS study group diagnostic criteria. Results: Most of our patients were women (52%). The mean age was 40.96±13.34 years and the mean disease duration was 46.16±41.98 months. RLS was detected in 36 (35.3%) of the patients with LBP. It was found that the female gender was more dominant in patients with RLS and the difference was statistically significant (p < 0.001). The amount of coffee intake was significantly higher in patients with RLS compared to those without RLS (p = 0.001). The disease duration for LBP was significantly higher in the patients with RLS (p = 0.003). VAS score, ODI score, PUKI score, and Beck depression score were significantly higher in the RLS group (p value were 0.048, 0.040, 0.007, and 0.043, respectively). In the evaluation of quality of life, all parameters except role emotional limitations and mental health were found to be significantly worse in the RLS group.

The effect of cardiac rehabilitation on kinesiophobia in patients with coronary artery disease.

OBJECTIVES: The aim of this study was to define the level of kinesiophobia in cardiac patients, to determine whether there was a positive change in kinesiophobia after an exercise based cardiac rehabilitation (CR), and to define the associated variables with the change in kinesiophobia. PATIENTS AND METHODS: Between September 2017 and December 2018, a total of 98 patients (63 males, 35 females; mean age: 58±10.4 years; range, 36 to 78 years) diagnosed with coronary artery disease (CAD) were included in the study. The Tampa Scale for Kinesiophobia Heart (TSK-SV Heart) was used to measure kinesiophobia. The short form of the International Physical Activity Questionnaire (IPAQ) was applied to measure physical activity level. The Short Form 36 (SF-36) was used to measure health-related quality of life (HRQoL). After CR, kinesiophobia was reevaluated. RESULTS: A high level of kinesiophobia was present in 74.5% of the patients. The mean TSK-SV heart score was 41.4±6.2. After CR, 34.6% of the patients had a high level of kinesiophobia (p<0.001). The patients with a high level of kinesiophobia were physically more inactive than those with a low level of kinesiophobia (p=0.001) and HRQoL scores were significantly lower (p<0.05). CONCLUSION: Kinesiophobia is quite common in patients with CAD. Aerobic exercise capacity and physical activity levels are lower in patients with a high level of kinesiophobia, compared to those with a low level of kinesiophobia. After an exercise-based CR program, kinesiophobia significantly reduces.

Redirected nuclear glutamate dehydrogenase supplies Tet3 with α-ketoglutarate in neurons.

Tet3 is the main α-ketoglutarate (αKG)-dependent dioxygenase in neurons that converts 5-methyl-dC into 5-hydroxymethyl-dC and further on to 5-formyl- and 5-carboxy-dC. Neurons possess high levels of 5-hydroxymethyl-dC that further increase during neural activity to establish transcriptional plasticity required for learning and memory functions. How αKG, which is mainly generated in mitochondria as an intermediate of the tricarboxylic acid cycle, is made available in the nucleus has remained an unresolved question in the connection between metabolism and epigenetics. We show that in neurons the mitochondrial enzyme glutamate dehydrogenase, which converts glutamate into αKG in an NAD+-dependent manner, is redirected to the nucleus by the αKG-consumer protein Tet3, suggesting on-site production of αKG. Further, glutamate dehydrogenase has a stimulatory effect on Tet3 demethylation activity in neurons, and neuronal activation increases the levels of αKG. Overall, the glutamate dehydrogenase-Tet3 interaction might have a role in epigenetic changes during neural plasticity.

Exercise-Based Cardiac Rehabilitation Has a Strong Relationship with Mean Platelet Volume Reduction. / Reabilitação Cardíaca Baseada em Exercícios Fortemente Relacionada com Redução do Volume Plaquetário Médio.

BACKGROUND: Mean platelet volume (MPV), which is a simple measure of platelet activation, has recently become an interesting topic in cardiovascular research. Exercise-based cardiac rehabilitation (CR) is a comprehensive intervention that decreases mortality-morbidity in patients with coronary artery disease (CAD). Studies on the effects of exercise on platelet activation have yielded conflicting results. OBJECTIVE: The purpose of this study was to determine the effect of an exercise-based CR programs on MPV in patients with stable CAD. METHODS: The sample was composed of 300 consecutive stable CAD patients. The patients were divided into two groups: CR group (n = 97) and non-CR group (n = 203). Blood analysis was performed. Point-Biserial correlation measures were performed to show correlation between MPV change and CR. A p value of <0.05 was considered statistically significant. RESULTS: The decrease in MPV was greater in the CR group than in the non-CR group [(-1.10(-1.40-(-0.90)) vs. (-0.10 (-2.00-0.00)); p< 0.001]. ΔMPV had a positive correlation with Δ neutrophil (r = 0.326, p < 0.001), ΔTG (r = 0.439, p < 0.001), ΔLDL-c (r = 0.478, p < 0.001), ΔWBC (r = 0.412, p < 0.001), and ΔCRP (r = 0.572, p < 0.001). A significant correlation was found between ΔMPV% and CR (r=0.750, p<0.001). CONCLUSIONS: We were able to show that exercise-based CR has a strong relationship with MPV reduction in patients with CAD. We consider that decreased platelet activation with exercise-based CR might play an important role in reducing thrombotic risk in patients with stable CAD. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).

FUNDAMENTO: O volume plaquetário médio (VPM), uma medida simples de ativação plaquetária, tornou-se recentemente um tópico interessante no campo da pesquisa cardiovascular. A reabilitação cardíaca (RC) baseada em exercícios é uma intervenção abrangente que diminui a morbidade-mortalidade em pacientes com doença arterial coronariana (DAC). Estudos sobre os efeitos do exercício físico na ativação plaquetária têm produzido resultados conflitantes. OBJETIVO: O objetivo deste estudo foi determinar o efeito de um programa de RC baseado em exercícios sobre o VPM em pacientes com DAC estável. MÉTODOS: A amostra foi composta por 300 pacientes consecutivos com DAC estável. Os pacientes foram divididos em dois grupos: grupo RC (n = 97) e grupo não RC (n = 203). Foi feito um hemograma. As medidas de correlação ponto-bisserial foram tiradas para mostrar a correlação entre a alteração do VPM e a RC. Valor de p<0,05 foi considerado estatisticamente significativo. RESULTADOS: A diminuição do VPM foi maior no grupo CR do que no grupo não CR [(-1,10 (-1,40-(-0,90)) vs. (-0,10 (-2,00-0,00)); p<0,001]. ΔVPM teve correlação positiva com Δ neutrófilos (r = 0,326, p<0,001), ΔTG (r = 0,439, p<0,001), ΔLDL-c (r = 0,478, p<0,001), ΔGB (r = 0,412, p<0,001) e ΔPCR (r = 0,572, p <0,001). Foi encontrada uma correlação significativa entre ΔVPM% e CR (r = 0,750, p <0,001). CONCLUSÕES: Pudemos mostrar que a RC baseada em exercícios tem forte relação com a redução do VPM em pacientes com DAC. Consideramos que a diminuição da ativação plaquetária com RC baseada em exercícios pode desempenhar um papel importante na redução do risco trombótico em pacientes com DAC estável. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).

The prevalence of sacroiliitis in patients with acne vulgaris using isotretinoin.

BACKGROUND/OBJECTIVE: Acne vulgaris is a chronic inflammatory disease affecting the pilosebaceous unit in the skin. Isotretinoin is a synthetic vitamin A derivative regarded as the most effective agent in the treatment of acne. There have recently been increasing reports of adverse effects of isotretinoin on the skeletal system. Our aim in this study was to evaluate the rheumatic side-effects triggered by this drug, and particularly the prevalence of sacroiliitis. MATERIALS AND METHODS: A total of 73 patients receiving isotretinoin due to moderate or severe acne vulgaris were included. All patients were questioned about inflammatory low back pain and musculoskeletal pains during the treatment process. Inflammatory low back pain was evaluated using Assessment of Spondyloarthritis International Society (ASAS) criteria. Patients meeting ASAS criteria were evaluated with radiography and when necessary with sacroiliac magnetic resonance. RESULTS: The dose range for isotretinoin was between 0.4 and 0.8 mg/kg/day (mean 0.53 mg/kg/day). Treatment lasted for 6-8 months (mean 6.8 months). Lethargy was determined in 37 (50.7%) patients, myalgia in 31 (42.5%) and low back pain in 36 (49.3%). Mechanical low back pain symptoms were present in 20 of the patients describing low back pain and inflammatory low back pain in 16. Acute sacroiliitis was determined in six patients (8.2%) following a sacroiliac magnetic resonance imaging (MRI). Five (83.3%) of the patients with sacroiliitis were female and one (16.7%) was male. No statistically significant difference was determined between male and female patients in terms of prevalence of sacroiliitis (p = 0.392). CONCLUSION: The incidence of sacroiliitis in patients using isotretinoin is quite high. Patients using isotretinoin must be questioned about sacroiliitis findings and must be subjected to advanced assessment when necessary. Further studies regarding the development of sacroiliitis under isotretinoin therapy are now needed.