Effects of adding interactive videogames to conventional rehabilitation program on radiological progression and upper extremity motor function in patients with hemiplegic stroke: a preliminary study.

OBJECTIVES: To investigate the effects of adding interactive videogames to conventional rehabilitation programmes on radiological progression and upper extremity functional status. PATIENTS AND METHODS: A total of 18 patients with hemiplegic stroke were randomized into two groups as conventional rehabilitation (control) group (n = 9), and the conventional rehabilitation + interactive videogames (intervention) group (n = 9). Each group received a 4-week program (5 days/week). Radiological progression (diffuse tensor imaging), and upper extremity functional status (upper extremity motor functioning part of the Fugl Meyer Assessment, self-care part of the Functional Independence Measure (FIM), and Motor Activity Log) were assessed at baseline and 4-week later. RESULTS: While no changes were detected in radiological status in the intervention group (p > 0.05), some regions on the affected side were improved significantly in the control group (p < 0.05). Total upper extremity motor functioning part of the Fugl Meyer Assessment scores and the self-care part of the FIM scores significantly improved in both groups (p < 0.05). No differences were detected in the amount of changes between groups (p > 0.05). CONCLUSION: According to our results, adding videogames to a conventional rehabilitation program does not seem enhancing the radiological progression or the functional status of the upper extremities.

Bilateral Multilevel Cervical Rib and Bilateral Omovertebra in Klippel-Feil Syndrome.

BACKGROUND: Klippel-Feil syndrome was first described in 1912; a short neck, low posterior hairline, and decreased cervical joint range of motion are the classical triad of this disease. In this syndrome, which is rarely observed, the characteristics that have been reported include the following: scoliosis; Sprengel deformity; cervical rib; ear, nose, oral, and laryngeal abnormalities; structural abnormalities of the urinary system; and congenital heart diseases. However, bilateral omovertebra and bilateral multilevel cervical ribs have not been reported. CASE DESCRIPTION: We aimed to present this rare syndrome via radiologic findings from cases with bilateral multilevel cervical rib and bilateral omovertebra. CONCLUSIONS: Cases of Klippel-Feil syndrome may be accompanied by multiple abnormalities. We want to highlight the need for detailed examination of patients and lifestyle modification at an early age, before symptom appearance, as well as adaptation to habitual exercise.

False Negative D Vitamin Measurement in LC-MS/MS Method Due to Hyperlipidemia: Case Report.

BACKGROUND: Lipemia can influence laboratory test results by different mechanisms. Although the liquid chromatography-tandem mass spectrometry (LC-MS/MS) is considered the reference method for 25(OH)D3, some compounds (carbohydrate, lipids, proteins, etc.) in the blood may cause a false result indicating a negative or positive deviation rate from the correct blood level of the test. CASE REPORT: In this paper, we report a case of D vitamin intoxication due to a false negative result caused by lipemia. A young woman with a complaint of pain in multiple joints applied to the physical therapy clinic and was found to have some cystic bone lesions. She was eventually diagnosed with DM tip 1, familial hyperlipidemia, and nephrolithiasis. Although she had D vitamin replacement therapy, low levels of blood 25(OH)D3 concentration, measured by an LC-MS/MS device, were detected. After blood dilution, a high level of 25(OH)D3 and blood intoxication due to lipid interference were indicated. CONCLUSION: From this case, we can conclude that analytical errors caused by the ingredients of a blood sample may lead to unnecessary treatment and intoxication. While evaluating the blood 25(OH)D3 levels, clinicians should guard against false-negative results due to interference in patients with familial hyperlipidemia.

Epicardial adipose tissue thickness as a new risk factor for atherosclerosis in patients with ankylosing spondylitis.

PURPOSE: The aim of this study was to compare epicardial adipose tissue thickness (EATT), which is a novel cardiometabolic risk factor in patients with ankylosing spondylitis (AS), and carotid intima media thickness (CIMT) with healthy controls to assess the relationship between these markers and disease activity. MATERIALS AND METHODS: This study involved 38 patients with AS and 38 controls with no history of cardiovascular disease. CIMT was measured by Doppler ultrasound, and EATT by echocardiography, in all participants. Total cholesterol (TC), low density lipoprotein (LDL) cholesterol, high density lipoprotein cholesterol, triglycerides, thyroid stimulating hormone, erythrocyte sedimentation rate, C-reactive protein, and hemogram measurements were performed in all subjects after 8 hours of fasting. In addition, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Bath Ankylosing Spondylitis Functional Index (BASFI) scores of the patients with AS were recorded. RESULTS: EATT was significantly higher in patients with AS (0.45 ± 0.17 mm) compared with healthy (0.37 ± 0.10 mm) controls (p= 0.01). Significant positive correlations were detected between EAT thickness and BASFI, CIMT, and disease duration in patients with AS (p= 0.008, p= 0.024, and p= 0.012, respectively). Significant negative correlations were observed between EATT and TC and LDL cholesterol concentrations (p= 0.016 and p= 0.009, respectively). No significant difference was detected in CIMT between the patients (0.515 ± 0.08 mm) and the controls (0.517 ± 0.094 mm, p= 0.98). No significant correlation was observed between CIMT of the patients with AS and the BASDAI, BASFI, TC, HDL cholesterol, systolic blood pressure, or diastolic blood pressure values. Significant positive correlations were observed between CIMT and waist circumference, weight, body mass index, and LDL cholesterol in patients with AS and the controls. CONCLUSIONS: This study demonstrated increased EATT in patients with AS compared with a healthy population, which was positively correlated with disease duration and BASFI.

Clinical characteristics affecting motor recovery and ambulation in stroke patients.

[Purpose] To describe the clinical characteristics affecting motor recovery and ambulation in stroke patients. [Subjects and Methods] Demographic and clinical characteristics of 53 stroke patients (31 M, 22 F), such as age, gender, etiology, hemiplegic side, Brunnstrom stage, functional ambulation scale scores, history of rehabilitation, and presence of shoulder pain and complex regional pain syndrome were evaluated. [Results] The etiology was ischemic in 79.2% of patients and hemorrhagic in 20.8%. Brunnstrom hand and upper extremity values in females were lower than in males. Complex regional pain syndrome was observed at a level of 18.9% in all patients (more common in females). Brunnstrom hand stage was lower in complex regional pain syndrome patients than in those without the syndrome. Shoulder pain was present in 44.4% of patients. Brunnstrom lower extremity values and functional ambulation scale scores were higher in rehabilitated than in non-rehabilitated cases. [Conclusion] Brunnstrom stages of hand and upper extremity were lower and complex regional pain syndrome was more common in female stroke patients. Shoulder pain and lower Brunnstrom hand stages were related to the presence of complex regional pain syndrome.

Comparison of the Efficacy of Dry Needling and High-Power Pain Threshold Ultrasound Therapy with Clinical Status and Sonoelastography in Myofascial Pain Syndrome.

OBJECTIVE: The aim of this study was to compare the therapeutic efficacy of high-power pain threshold (HPPT) ultrasound therapy applied to the trigger points and dry needling (DN) in myofascial pain syndrome. DESIGN: Sixty-one patients were randomly assigned to an HPPT (n = 30) and dry needling (n = 31) groups. The primary outcome measures were the Visual Analog Scale (VAS) and Neck Pain and Disability Scale (NPDS), both at 1 week and 4 weeks after treatment. The secondary outcome measures were the number of painful trigger points, range of the tragus-acromioclavicular joint, the Short Form-36, the Beck Depression Inventory, the Beck Anxiety Inventory, and sonoelastographic tests after a 1-week treatment. RESULTS: More improvement was seen in anxiety in the HPPT group (P < 0.05). However, no significant differences were found between the groups with regard to other parameters (P > 0.05). A decrease in tissue stiffness was only seen in the HPPT group (P < 0.05). Significant posttreatment improvements were seen on all clinical scales in both groups (P < 0.05). After a treatment period of 4 weeks, a significant improvement was also observed on the visual analog scale and NPDS (P < 0.05). CONCLUSIONS: Our study favors the efficacy of both treatment methods in myofascial pain syndrome. Although a significant decrease was shown in tissue stiffness with HPPT, neither of these treatments had an apparent superiority.

Evaluation of ceruloplasmin levels in patients with lumbar disc herniation.

BACKGROUND: Chronic inflammation is believed to have a role in the development of lumbar disc herniation (LDH). Ceruloplasmin (CP), an acute phase protein, is known to limit inflammation. OBJECTIVE: To evaluate CP levels in patients with LDH. METHODS: Thirty-five patients with LDH and 35 healthy individuals were enrolled in the study. Participants were divided into two groups; group 1 (n = 35) consisted of patients with LDH, and group 2 (n = 35) consisted of healthy subjects. Surgery specimens were taken from all patients who underwent LDH-related surgery. CP levels were measured in both blood and tissue samples. Pain intensity was evaluated using a visual analog scale (VAS). RESULTS: There were no significant differences in gender, age, or body mass index between the control and LDH patients (p > 0.05 for all). Compared with the control patients, LDH patients had significantly higher serum CP levels (p < 0.001). In LDH patients, tissue CP levels were significantly higher than serum levels (p < 0.001). According to bivariate analysis, the serum CP levels were significantly correlated with the VAS score in group 1 (r = 0.491, p = 0.003). CONCLUSIONS: The present study showed that CP levels increased in both the serum and the tissues of patients with LDH compared to patients without LDH, possibly as a consequence of LDH-associated inflammation.

Isokinetic muscle performance of the hip and ankle muscles in women with fibromyalgia.

OBJECTIVE: To compare isokinetic muscle performances of a proximal (hip) and a distal (ankle) muscle of fibromyalgia syndrome (FMS) patients with those of age- and body mass index (BMI)-matched healthy subjects. METHODS: Thirty female patients with FMS (mean age: 41.5 ± 6.7 years [range, 27-54]) and 30 age- (mean age: 40.6 ± 6.0 years [range, 27-54]) and BMI-matched female healthy controls were consecutively enrolled. Demographic and clinical characteristics of the subjects were recorded. Isokinetic measurements of hip and ankle flexion and extension at angular velocities of 60°/s and 180°/s, peak torques, flexor-extensor torque ratios, muscle fatigue resistance values and average power were obtained. RESULTS: Mean disease duration of FMS patients was 2.4 ± 1.9 years. Mean weight, height and BMI values were 70.4 ± 12.5 kg, 159.5 ± 6.0 cm and 27.7 ± 4.7 kg/m² (FMS patients) and 69.3 ± 10.1 kg, 161.7 ± 6.2 cm and 26.6 ± 4.3 kg/m² (control subjects), respectively (all P > 0.05). All isokinetic values were statistically decreased in the FMS group when compared with the control group, except for the peak torques at angular velocity of 180°/s on flexion of the hip and extension of the ankle and the total work and average power on extension of the ankle. We did not find any correlation between isokinetic values and disease related parameters of FMS patients. CONCLUSIONS: In the light of our results, we may conclude that muscle strength and muscle fatigue seem to decrease in FMS patients' both proximal and distal lower extremity muscles.

Platelet and Erythrocyte Indexes in Complex Regional Pain Syndrome Type I.

OBJECTIVES: This study aims to compare the levels of platelet and erythrocyte indexes including mean platelet volume, platelet distribution width (PDW), and red blood cell distribution (RDW) values between complex regional pain syndrome (CRPS) type I patients and healthy controls to establish a marker of neuroinflammation that might be a potential factor involved in CRPS etiopathogenesis. PATIENTS AND METHODS: A total of 21 patients (14 males, 7 females; mean age 35.0±15.4 years; range 15 to 69 years) with a diagnosis of CRPS type I and 44 age- and sex-similar healthy controls (29 males, 15 females; mean age 35.8±8.5 years; range 16 to 53 years) were included in this study. Mean platelet volume, PDW, RDW, white blood count, hemoglobin, erythrocyte sedimentation rate, and C-reactive protein levels, and neutrophil to lymphocyte ratio and thrombocyte to lymphocyte ratio were compared between the patient and control groups. RESULTS: No differences were noted between patient and control groups in terms of erythrocyte sedimentation rate and C-reactive protein levels, white blood cell, neutrophil, lymphocyte and thrombocyte counts, and neutrophil to lymphocyte and thrombocyte to lymphocyte ratios (all p>0.05). When compared with controls, patients had significantly higher mean corpuscular volume (p=0.019) and RDW (p=0.002) values, and a lower PDW level (p=0.006). CONCLUSION: Differences in PDW, RDW, and mean corpuscular volume values between patients and controls might support the potential role of neuroinflammation in the etiopathogenesis of CRPS type I. Prospective studies with larger sample sizes are warranted in the early detection and differential diagnosis of CRPS type I.

Effectiveness of a home exercise program in combination with ultrasound therapy for temporomandibular joint disorders.

[Purpose] This study compared the effectiveness of home exercise alone versus home exercise combined with ultrasound for patients with temporomandibular joint disorders. [Subjects and Methods] This study enrolled 23 female and 15 male patients who were divided randomly into two groups. The home exercise group performed a home exercise program consisting of an exercise program and patient education, and the home exercise combined with ultrasound group received ultrasound therapy in addition to the home exercise program. Pain intensity was evaluated using a visual analogue scale. Pain free maximum mouth opening was evaluated at baseline and 2 weeks after the treatment. [Results] There was no difference between the two groups in baseline values. After the treatment, the visual analogue scale decreased and pain free maximum mouth opening scores improved significantly in each group. Additionally, both values were higher in the home exercise combined with ultrasound group than in the home exercise group. [Conclusion] The combination of home exercise combined with ultrasound appears to be more effective at providing pain relief and increasing mouth opening than does home exercise alone for patients with temporomandibular joint disorders.

Evaluation of open and closed kinetic chain exercises in rehabilitation following anterior cruciate ligament reconstruction.

[Purpose] To compare outcomes of anterior cruciate ligament (ACL) reconstruction after open kinetic chain (OKC) exercises and closed kinetic chain (CKC) exercises. [Subjects and Methods] The subjects comprised 11 female and 47 male patients who are randomly divided into two groups: which performed a CKC exercise program Group I and Group II which performed an OKC exercise program. Pain intensity was evaluated using visual analogue scale (VAS). Knee flexion was evaluated using a universal goniometer, and thigh circumference measurements were taken with a tape measure at baseline and at 3 months and 6 months after the treatment. Lysholm scores were used to assess knee function. [Results] There were no significant differences between the two groups at baseline. Within each group, VAS values and knee flexion were improved after the surgery. These improvements were significantly higher in the CKC group than in the OKC group. There were increases in thigh circumference difference at the 3 and 6 month assessments post-surgery. A greater improvement in the Lysholm score was observed in the CKC group at 6 months. [Conclusion] The CKC exercise program was more effective than OKC in improving the knee functions of patients with ACL reconstruction.

Rheumatoid Arthritis and Familial Mediterranean Fever or Sacroiliitis Accompanied by FMF.

The coexistence of rheumatoid arthritis (RA) and familial Mediterranean fever (FMF) has been rarely seen in case reports in the literature. Herein, we wanted to present a patient who had been followed up and treated as RA, but on investigation we concluded that he really had FMF and its joint complaints associated with sacroiliitis. Recovery was achieved by etanercept administered as if he was an RA patient.