Pain types and risk factors in post-COVID-19.

Objectives: This study aims to accurately evaluate pain lasting longer than three months and falls under the category of chronic pain and to determine the risk factors to follow up and treat properly and to develop appropriate diagnostic and treatment algorithms. Patients and methods: Between March 2021 and December 2021, a total of 437 patients (162 males, 275 females; mean age: 44±14.6 years; range, 12 to 82 years) who were referred to the participating centers due to pain complaints and were diagnosed with post-COVID-19 condition according to the criteria defined by the World Health Organization (WHO) were included in the study. The patients were divided into three groups as nociceptive pain, neuropathic pain, and central sensitization, based on the physician's clinical evaluation and the Self-Report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) and Central Sensitization Inventory scores. Results: The most common diagnosis was nociceptive pain followed by central sensitization. Patients with nociceptive pain had less pain. It was found that not exercising regularly, having a chronic disease and being a woman were risk factors for central sensitization, having thyroid disease before COVID-19, and defining the current pain as very severe were risk factors for neuropathic pain. Conclusion: In the evaluation of post-COVID-19 pain, neuropathic pain and central sensitization should be also considered in addition to nociceptive pain and the severity of pain, systemic diseases and physical activity should be questioned.

Does fear of activity predict exercise capacity in patients with coronary artery disease in both sexes? A cross-sectional multicenter study.

Objectives: This study aimed to identify whether fear of activity predicts exercise capacity in patients with coronary artery disease (CAD) and whether there is a difference between sexes regarding this relationship. Patients and methods: One hundred ninety-seven patients (145 males, 52 females; mean age: 56.3±10.8 years; range, 22 to 80 years) with a diagnosis of CAD or cardiac event in the previous one to 60 months were enrolled in this cross-sectional multicenter study between November 2015 and February 2017. Demographic and clinical features were recorded. Fear of activity was assessed by the fear of activity scale in patients with CAD (FactCAD). A 6-min walk test was used to assess exercise capacity. Results: Female participants were older, less educated, and less employed (p=0.045, p=0.048, and p<0.001, respectively) than males. Prevalence of myocardial infarction was higher in males. Comorbidities were higher in females. Multiple linear regression predicted 6-min walk distance (6MWD) based on FactCAD, sex, and education level with an r-squared of 0.321 (p<0.001). Fear of activity had an effect on walking distance in males (each additional score of FactCAD predicts a decrease of 1.3 m in 6MWD), together with disease duration, presence of chronic pulmonary disease, and low back pain, whereas fear of activity was not a predicting factor on walking distance in females. Age, education, and presence of angina predicted 6MWD in females. Conclusion: This study emphasizes that fear of activity is one of the predictors of 6MWD in males with CAD, and its assessment is recommended as a possible barrier to rehabilitation.

Acute effect of kinesiotaping on pain, balance and gait performance in patients with knee osteoarthritis: A randomized controlled study.

BACKGROUND: Kinesiotape application is one of the non-pharmacological methods frequently used in patients with knee OA. Guidelines do not have a consensus on its use in knee osteoarthritis (OA). OBJECTIVE: In this study, we aimed to investigate the acute effect of kinesiotape application on pain, balance, and gait performance in patients with knee OA. METHODS: We included 164 patients with grade 1-3 knee OA according to the Kellgren-Lawrence staging system in the study. Patients were evaluated with visual analog scale (VAS), 10-meter walking test (10MeWT), timed-up and go test (TUG-T), single leg stance test (SLST), and functional reach test (FRT) before and after taping. RESULTS: There was a significant improvement in the post-taping scores of all evaluation parameters in the kinesiotaping group compared with pre-taping scores. Statistically significant improvement was found in all scores of evaluated parameters except FRT scores in the placebo taping group. We found a significant superiority in the mean recovery scores of the kinesiotaping group compared to the placebo-taping group in all parameters except for 10MeWT. CONCLUSIONS: We found significant improvements in both groups. The mean improvement levels in pain and balance scores were better in the KT group than in the PT group.

Pulmonary rehabilitation principles in SARS-COV-2 infection (COVID-19): The revised guideline for the acute, subacute, and post-COVID-19 rehabilitation.

Coronavirus disease 2019 (COVID-19) is a contagious infection disease, which may cause respiratory, physical, psychological, and generalized systemic dysfunction. The severity of disease ranges from an asymptomatic infection or mild illness to mild or severe pneumonia with respiratory failure and/or death. COVID-19 dramatically affects the pulmonary system. This clinical practice guideline includes pulmonary rehabilitation (PR) recommendations for adult COVID-19 patients and has been developed in the light of the guidelines on the diagnosis and treatment of COVID-19 provided by the World Health Organization and Republic of Turkey, Ministry of Health, recently published scientific literature, and PR recommendations for COVID-19 regarding basic principles of PR. This national guideline provides suggestions regarding the PR methods during the clinical stages of COVID-19 and post-COVID-19 with its possible benefits, contraindications, and disadvantages.

Pulmonary rehabilitation principles in SARS-COV-2 infection (COVID-19): A guideline for the acute and subacute rehabilitation.

Coronavirus disease 2019 (COVID-19) is a contagious infection disease, which may cause respiratory, physical, psychological, and generalized systemic dysfunction. The severity of disease ranges from an asymptomatic infection or mild illness to mild or severe pneumonia with respiratory failure and/or death. COVID-19 dramatically affects the pulmonary system. There is a lack of knowledge about the long-term outcomes of the disease and the possible sequelae and rehabilitation. This clinical practice guideline includes pulmonary rehabilitation (PR) recommendations for adult COVID-19 patients and has been developed in the light of the guidelines on the diagnosis and treatment of COVID-19 provided by the World Health Organization and Republic of Turkey, Ministry of Health, recently published scientific literature, and PR recommendations for COVID-19 regarding basic principles of PR. In this guideline, the contagiousness of COVID-19, recommendations on limited contact of patient with healthcare providers, and the evidence about possible benefits of PR were taken into consideration.

Premenstrual syndrome and fibromyalgia: the frequency of the coexistence and their effects on quality of life.

OBJECTIVE: We aimed to investigate the association between Premenstrual syndrome (PMS) and fibromyalgia syndrome (FMS), to assess common symptoms and quality of life (QOL) of them. METHODS: Patients with PMS formed the PMS group and age-matched healthy normal controls were included in the control group. The diagnosis of the FMS and PMS were based on new American College of Rheumatology FMS criteria and DSM-IV PMS criteria. FMS-related symptoms assessed by visual analog scale and number of tender points (TePs) were analyzed. QOL, PMS severity and FMS severity were assessed with SF-36, fibromyalgia impact questionnaire (FIQ) and premenstrual assessment form (PAF), respectively. Patients with PMS were divided into two subgroups according to coexistence of FMS or not. RESULTS: The frequency of FMS in PMS and control group were 20 and 0%, respectively (p = 0.002). FMS-related symptoms, number of TePs in the PMS group were higher than those in the control group. The mean mental component summary (MCS) score of SF-36 was low in the PMS group. The mean PAF score in PMS with FMS subgroup was higher than those in without FMS subgroup. The mean physical component summary of SF-36 was low in the PMS patient with FMS. There was correlation between PAF score and FIQ score (r = 0.476, p < 0.001). CONCLUSION: FMS was common among the patients with PMS and frequently seen in the PMS patients having severe premenstrual complaints. Mental QOL was distressed in the patients with PMS but while FMS accompanied to PMS, the physical QOL was decreased.

The evaluation of anxiety and depression status in spouses of sexually active reproductive women with fibromyalgia.

OBJECTIVES: Fibromyalgia (FM) can cause neuropsychiatric symptoms and sexual dysfunction. However, no data exist regarding anxiety and depression status in spouses of sexually active women with FM. Accordingly, we aimed to evaluate whether emotional status are affected in spouses of women with FM, and to search whether there was a relationship between sexual dysfunction of women with FM and emotional status of their spouses. METHODS: Thirty newly diagnosed, never treated reproductive women with FM and 30 age-matched healthy women as well as their spouses were included. Psychological status was evaluated using Beck depression/anxiety inventory (BDI/BAI). Sexual function was evaluated using Female Sexual Function Index (FSFI) and Index of Female Sexual Function (IFSF). RESULTS: BDI, BAI, FSFI and IFSF scores were significantly higher in women with FM than in controls. The spouses of women with FM had increased BDI and BAI scores as compared to spouses of controls (7.10 ± 7.76 vs. 2.10 ± 2.68, 6.96 ± 6.62 vs. 2.20 ± 3.16, respectively, p<0.001). BDI scores of women with FM significantly correlated to BDI scores of their spouses, but there was no significant relationship between BDI scores of spouses and sexual functions of women with FM. CONCLUSIONS: FM can cause deterioration of emotional status and lead to sexual dysfunction. Also, psychological status could be affected in spouses of women with FM at reproductive age, and the severity of depression of their spouses was significantly correlated to that of women with FM. However, this affection in psychological status did not relate to sexual problems of the women with FM.

Physical and mental workload in single-incision laparoscopic surgery and conventional laparoscopy.

OBJECTIVES: The aim of the present study is to evaluate mental workload and fatigue in fingers, hand, arm, shoulder in single-incision laparoscopic surgery (SILS) and multiport laparoscopy. METHODS: Volunteers performed chosen tasks by standard laparoscopy and SILS. Time to complete tasks and finger and hand strength were evaluated. Lateral, tripod, and pulp pinch strengths were measured. Hand dexterity was determined by pegboard. Electromyography recordings were taken from biceps and deltoid muscles of both extremities. The main outcome measurement was median frequency (MF) slope. NASA-TLX was used for mental workload. RESULTS: Time to complete laparoscopic tasks were longer in the SILS group (P < .05). Decrease of strength in fingers and hand were similar in SILS and standard laparoscopy. Pegboard time was increased in both hands after SILS (P < .05). MF slope of biceps muscle and deltoid muscle in SILS was far away from the reference slope. MF slope of biceps muscle and deltoid muscle in standard laparoscopy was close to reference slope, indicating there was more fatigue in biceps and deltoid muscles of both upper extremities in SILS group. NASA-TLX score was 73 ± 13.3 and 42 ± 19.5 in SILS and multiport laparoscopy, respectively (P < .01). Mental demand, physical demand, temporal demand, performance, effort, and frustration were, respectively, scored 10.7 ± 3.8, 11.7 ± 3.5, 12.2 ± 2.7, 11 ± 3, 13.6 ± 2.7, and 13.5 ± 2.8 in SILS and 6.3 ± 3.1, 6.6 ± 3.3, 7.3 ± 3.3, 7.1 ± 4.1, 7.9 ± 3.9, and 6.6 ± 3.8 in standard laparoscopy (P < .01). CONCLUSIONS: SILS is mentally and physically demanding, particularly on arms and shoulders. Fatigue of big muscles, effort, and frustration were major challenges of SILS. Ergonomic intervention of instruments are needed to decrease mental and physical workload.

The upper extremity musculoskeletal complications in dialysis patients: comparison between hemodialysis and peritoneal dialysis.

OBJECTIVES: The aim of this study was to compare the upper extremity musculoskeletal complications in the patients who had been receiving hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). MATERIAL AND METHODS: The patients who had been receiving HD (n=17) or CAPD (n=15) were included to the study. The age, gender, duration of dialysis were recorded. The physical findings related to musculoskeletal system in the upper extremity were researched. The cervical, shoulder, hand standard radiographies and shoulder magnetic resonance imaging were investigated. RESULTS: The mean duration of HD and CAPD were 53.60 ± 36.03 and 49.17 ± 33.14 months, respectively (p=0.720). Only 6.3% of the CAPD group had signs of carpal tunnel syndrome (CTS). There were not any differences in the frequency of cervical destructive spondyloarthropathy, decreased height of vertebral corpus in the examination of cervical radiography (p=0.579) and also in the frequency of erosions in the humeral head and bones of hand, cyst in the clavicula, erosive osteoarthropathy and osteoporosis detected in the bones of hands (p> 0.005). In the examination of shoulder MR imaging, 80% of the HD group and 47.1% of the CAPD group had supraspinatus tendinitis (p=0.059). The frequency of subscapularis, biceps and infraspinatus tendinitis were not different in HD and CAPD groups (p> 0.05). CONCLUSION: The musculoskeletal system complications of the upper extremity were common in the patients undergoing dialysis therapy. The most common complications were osteoporosis of the hand region and supraspinatus tendinitis. LEVEL OF EVIDENCE: Prospective, Level 2b.

The efficacy of phonophoresis on electrophysiological studies of the patients with carpal tunnel syndrome.

To investigate the efficacy of phonophoresis with nonsteroid anti-inflammatory drugs (P-NSAID) and corticosteroids (P-CS) in the treatment for carpal tunnel syndrome (CTS) and to compare the efficacy of phonophoresis with local CS injection (LCSI) and splinting with a 3-month follow-up. 84 hands of 51 patients with CTS were treated by applying LCSI, P-CS, P-NSAID, and wrist splinting. Electrophysiological studies, grip strength, hand dexterity, and sensory recovery of the first three digits were assessed. Duruöz hand index (DHI) was used to assess the functional hand disability. For clinical evaluation, we used Phalen and Tinnel signs. Pain intensity was evaluated by visual analog scale. The LCIS group showed a significant improvement in pain relief and DHI, but this group had significant deterioration in the results of monofilament and pegboard tests. The P-CS group showed improvement in sensory nerve conduction velocity, distal latency, grip strength, and DHI parameters. There was a significant improvement in grip strength, pegboard test, and pain intensity in the P-NSAID group. There was improvement only in pain intensity in the splinting group. We identified marked improvement in the electrophysiological studies in the P-CS group. Splinting had no effect on hand functions, disability, and electrophysiological studies.

Determining the effectiveness of various treatment modalities in carpal tunnel syndrome by ultrasonography and comparing ultrasonographic findings with other outcomes.

UNLABELLED: Firstly, we aimed to determine the effectiveness of various treatment modalities using ultrasonography (US), and secondly, we aimed to assess the correlations between the ultrasonographic findings and electrophysiological tests, symptom severity, functional status and physical findings. 74 hands of 47 patients with carpal tunnel syndrome (CTS) were randomly treated by applying wrist splinting alone in the neutral position (23 hands), phonophoresis with corticosteroid (PCS) (28 hands) and phonophoresis with non-steroid anti-inflamatory drug (PNSAI) (23 hands). The cross-sectional area (CSA) of the median nerve (MN) was determined by ultrasound on the initial and at the 3 months after treatment. MN conduction studies were performed on the initial visit and 3 months after treatment. The patients completed the Boston symptom severity questionnaire. For clinical evaluation, we used Phalen's and Tinel's signs. We could find reduction in CSA of MN in PCS group (P < 0.001). The CSA of MN was inversely correlated with motor sensory and median nerve conduction velocity (NCV) (r = 0.421, r = 0.213, respectively). Statistically significant correlations were not detected between ultrasonographic parameters and clinical evaluation parameters (P > 0.05) and also between ultrasonographic parameters and BQ scores (P > 0.05). Although there was some improvement in clinical parameters, ultrasonographic parameters did not change in P-NSAI group. CONCLUSION: The most effective treatment modality was P-CS according to ultrasonographic and other findings. Although there were inverse correlations between the CSA of MN and sensory and motor MN conduction velocity, no relationship was found between symptom severity, functional status and US findings or electrophysiological studies.

Vitamins C and E treatment combined with exercise modulates oxidative stress markers in blood of patients with fibromyalgia: a controlled clinical pilot study.

We aimed to investigate effects of vitamins C and E (VCE) supplementation with exercise (EX) on antioxidant vitamin and lipid peroxidation (LP) levels in blood of patients with fibromyalgia (FM). A controlled study was performed on blood samples from 32 female FM patients and 30 age-matched controls. The patients were divided into three groups namely EX (n = 10), VCE (n = 11), and EX plus VCE (n = 11) after taking basal blood samples. After 12 weeks of EX and VCE supplementation, blood samples were taken once more from the patients. LP levels in plasma and erythrocytes were higher in the patients at baseline than those in controls, whereas LP levels were lower in the VCE and EX groups at the end of 12 weeks than those at baseline. Plasma concentrations of vitamins A and E and reduced glutathione were lower in the patients than those in controls and their concentrations were increased by VCE and EX. Glutathione peroxidase activity in erythrocytes was increased by VCE supplementation, with or without EX. Concentrations of ß-carotene in the groups did not change with treatment. Despite the measured effects on anti-oxidative mechanisms, FM symptoms were not improved by the treatments. In conclusion, VCE with EX may protect against FM-induced oxidative stress by up-regulation of an antioxidant redox system in the plasma and erythrocytes of patients with FM. Such protective effects of VCE in the patients seemed to be greater in combination with EX than EX alone.

Do the self-concept and quality of life decrease in CP patients? Focussing on the predictors of self-concept and quality of life.

PURPOSE: To find out if the quality of life (QOL) and self-concept of the children with cerebral palsy (CP) was different from that of children without disability, to investigate predictive variables that could affect self-concept and QOL. METHODS: A total of 40 children with CP and 46 age-matched peers were included. The baseline characteristics including sex, type of CP, the level of disability according to Gross Motor Function Classification System (GMFCS) were recorded. Education levels of both children and parents, demographic features of parents, features of living area, usage of devices and associated impairments were filled out. Self-concept was measured using Piers-Harris Self-concept (PH) Scale. Quality of life was measured by Pediatric Quality of Life Inventory 4.0 (PedsQL). The physical and psychosocial health subscale scores of PedsQL (P-PedsQL and PS-PedsQL) were recorded. RESULTS: Significant differences in mean scores favouring the control group were found for PH scale, PedsQL scale (p < 0.001). P-PedsQL and PS-PedsQL of the CP group were lower than the control group (p < 0.001). PS-PedsQL report was significant predictor of self-concept. The presence of incontinence and GMFCS level were significant predictors of PedsQL and PPedsQL, respectively. CONCLUSION: Self-concept and QOL of the CP children were lower than the children without CP. Presence of incontinence, self-concept rating and GMFCS level were important to predict domains of QOL.

Effects of body weight supported treadmill training on cardiac and pulmonary functions in the patients with incomplete spinal cord injury.

We aimed to investigate the effects of body weight supported treadmill training (BWSTT) on cardio-pulmonary functions and on depression in subjects with incomplete spinal cord injury (SCI). Eight subjects (2 female, 6 male) with incomplete SCI participated in this study. Heart rate (HR), blood pressure (BP) and resting pulmonary function parameters were obtained from each subject at baseline and after BWSTT. The training programme was scheduled five times per week for six weeks. The psychological status was evaluated by Beck Depression Inventory (BDI). The post-BWSTT HR value was lower than the pre-training HR value (p< 0.05). In comparison of pre- and post-BWSTT pulmonary parameters, there were only significant improvement in FVC and IC (p< 0.05). The mean BDI score was lower after BWSTT compared to before BWSTT value. As a conclusion, 6 weeks BWSTT had positive effect on heart rate and limited effect on pulmonary functions. There was an improvement in depression level of the SCI subjects.

The rehabilitation programme of an adult phenylketonuria with upper motor neuron involvement.

Phenylketonuria (PKU) is a disorder characterized by several biochemical mechanisms which may impair the brain functions in PKU, leading to neurological problems. Our case report concerns a 19 year-old man with phenylketonuria who was evaluated with the onset of stiffness following the abandonment of the phenylalanine-restricted diet. He was assessed with grade-4 spasticity according to Modified Aschworth scale. The deep tendon reflexes had increased and the plantar reflexes were positive. Knee extensions were limited due to the shortening of the hamstring muscles. Serum phenylalanine concentration was elevated and plasma vitamin B12 level was low. Cranial magnetic resonance imaging scan revealed demyelinization area in periventricular deep white matter. We administered a phenylalanine-restricted diet and a rehabilitation program. Following the treatment, spasticity was reduced to grade-1 and patient could walk without aid. This case shows that, the combination of diet, medication and a rehabilitation program is an effective treatment model on adult PKU with upper motor neuron involvement.

Evaluation of hand functions in women with polycystic ovary syndrome.

OBJECTIVES: Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenemia and androgen levels are associated with muscle size and strength; thus we aimed to investigate the hand functions of women with PCOS. METHODS: Thirty-seven patients with PCOS and 35 age-matched healthy women were included in the study as PCOS and control groups. Age, body mass index, dominant hand, physical activity level, lean/fat mass ratio, percentage of body fat, Beck Depression Inventory (BDI) score and Duruoz Hand Index (DHI) score were recorded. Hand grip and pinch strengths were tested in the dominant hand using a hand dynamometer and a pinch meter, respectively. Manual dexterity was tested by the grooved pegboard test. Serum concentrations of total testosterone, estradiol, dehydroepiandrosterone sulfate, follicle-stimulating hormone, luteinizing hormone, thyroid-stimulating hormone and progesterone were measured. RESULTS: Patients with PCOS had high total testosterone levels (p < 0.001). There were no differences between groups in all of the hand strengths or dexterity. No correlations between hand parameters and hormones were found. DHI and BDI scores were high in the PCOS group (p = 0.002 and 0.039, respectively). There was a correlation between DHI and BDI scores. Depressive patients had higher BMI (p = 0.021) and body fat percentage (p = 0.05) than non-depressive patients in the PCOS group. CONCLUSION: Hand strength and dexterity did not change in patients with PCOS. Depression risk increased especially in the patients with high BMI and affected hand functional status in PCOS.

Correlation between BMD and bone scintigraphy in patients with prostate cancer.

OBJECTIVE: Bone metastasis is a major cause of morbidity in prostatic cancer. Therefore, detecting and monitoring bone lesions are crucial for treatment of prostatic carcinoma. We aimed to evaluate total body bone mineral density and regional bone mineral density in patients with prostate cancer with and without metastases, and to compare them with bone scintigraphy. METHODS: Fifty-four patients with prostatic carcinoma and 20 healthy subjects were investigated with bone scintigraphy and dual-energy X-ray absorptiometry. The bone scintigraphic findings were classified as normal (score 0: n = 22), abnormal but not typical for metastases (score 1: n = 18), and typical pattern of metastases (score 2: n = 14). RESULTS: The patients with bone metastases prostate cancer had significantly higher total bone mineral density and regional bone mineral density of trunk and pelvis than healthy controls and prostate cancer patients without bone metastases. There was a significant positive correlation between bone scan score and total bone mineral density and regional bone mineral density of trunk and pelvis (r = 0.328, P < 0.05, r = 0.60, P < 0.001, r = 0.480, P < 0.001, respectively). CONCLUSION: Our results show that patients of prostate cancer with bone metastases have increased bone mineral density (BMD) in the pelvis and trunk, possibly because of a predominance of osteoblastic over osteolytic metastases demonstrated by Tc-99m MDP bone scan.

Androgen deprivation therapy for prostate cancer: effects on hand function.

OBJECTIVES: Prostate cancer is the most frequently diagnosed malignancy. Luteinizing hormone-releasing hormone (LH-RH) agonists are used in most patients with locally advanced and metastatic prostate cancer, and decrease testosterone production. We aimed to find out the effects of androgen deprivation therapy with LH-RH agonist on the hand function, quality of life, and mood of the patients with prostate cancer. SUBJECTS: A total of 20 patients with locally advanced prostate cancer and 20 age-matched healthy men were included in the study as LH-RH and control groups, respectively. MAIN MEASURES: Age, body mass index, occupation and dominant hand, physical activity level, Beck depression inventory scores, 15D quality of life questionnaire scores, and Duruoz hand index scores were recorded. Handgrip strength was tested in the dominant hand using the Jamar hand dynamometer (Sammons Preston, Inc., Bollingbrook, IL). The Grooved Pegboard Test was used to test manual dexterity. Serum concentrations of total and free testosterone, estradiol levels were measured. RESULTS: There were no differences between the groups in body mass index, physical activity level, and age (P > 0.05). Serum total and free testosterone, estradiol level, and the mean grip strength score were statistically lower in the LH-RH group. Manual dexterity was diminished in the LH-RH group (P < 0.001). The Duruoz hand index, and Beck depression inventory and 15D quality of life questionnaire scores were statistically lower in the LH-RH group (P < 0.005). We found a correlation between handgrip strength, dexterity, Beck depression inventory scores, 15D quality of life questionnaire scores, and total and free testosterone. CONCLUSION: Men with low testosterone levels caused by androgen deprivation therapy have worse grip strength, dexterity, 15D quality of life questionnaire scores, and depressive symptoms than age-matched men who have not received androgen deprivation therapy.

Effect of homocysteine on bone mineral density of rats.

The relationship between plasma levels of homocysteine (Hcy) and femur bone mineral density (BMD) was studied in Wistar rats. After 8 weeks of treatment with 0.5 and 1.0 g kg(-1) day(-1) l-methionine the mean plasma levels of Hcy were 7.67 +/- 1.25 and 61.2 +/- 11.4 micromol/l, respectively. Only rats treated with the higher dose had Hcy levels significantly higher than those of controls, 6.38 +/- 0.90 micromol/l (p < 0.001). Dual Energy X-ray Absorptiometry was used to measure the BMD, which was significantly lower only in the animals with the highest plasma levels of Hcy (p < 0.001). This led us to conclude that increased levels of Hcy are associated with risk of decreased BMD.

Decreased handgrip strength and increased hip osteoporosis in patients with Alzheimer`s disease.

OBJECTIVE: To evaluate the causes of disability in the musculoskeletal system, and depression in patients with Alzheimer`s disease (AD) and healthy controls. METHODS: A case-controlled study in which healthy elderly patients (n=56) and patients with AD (n=75) attending the Geriatric Rehabilitation Unit of Ankara Education and Research Hospital, Department of Physical Medicine and Rehabilitation were compared on several measures of disability including handgrip strength, knee x-rays graded for osteoarthritis, dual-energy x-ray absorptiometry results for osteoporosis, and depression scores in the training period of 2003-2004. RESULTS: Handgrip strength values were significantly lower in patients with AD compared to the controls (19.4 versus 37 pounds force). Osteoporosis in the femoral neck was also more prominent in patients with AD compared to controls (T-scores: -2.1 versus -1.2). Handgrip strength was moderately correlated with femoral neck T-scores (r=0.6, p=0.001). CONCLUSION: Strategies should be developed to protect patients with AD from osteoporosis and reduced muscle strength.