Comparison of the effect of prolotherapy and paraffin wax for hand osteoarthritis.

OBJECTIVE: Hand osteoarthritis (OA) is associated with considerable disability, especially in the elderly patient population. Paraffin wax (PW) and prolotherapy (P) are non-pharmacological treatment methods used in this setting. This study aimed to compare the therapeutic efficacy of P and PW in hand osteoarthritis. PATIENTS AND METHODS: This study was designed as a single-center, randomized-controlled trial conducted at our Physical Medicine and Rehabilitation Clinic between February 2019 and July 2020. Patients with bilateral hand OA were divided into PW and P treatment groups. The PW group was treated 5 days per week for 2 weeks. The P group received an injection of dextrose solution into the ligaments of painful joints once weekly for three weeks. Visual analog scale (VAS), Duruoz Hand Index (DHI) scale, hand dynamometer for grip strength, and pinch meter for lateral pinch were used for baseline and post-treatment follow-up assessments. RESULTS: Overall, 42 patients were included. The VAS scores significantly decreased in both PW and P groups (p=0.024 and p=0.014). Baseline and third-month post-treatment VAS scores did not significantly differ (p=0.581). The DHI scores improved significantly in both groups (p<0.001 and p<0.001), being higher in the P than in the PW group (p=0.042). Right- and left-hand grip strength increased significantly in PW and P groups (p<0.001, p=0.001; p=0.013, p=0.002, respectively). CONCLUSIONS: Both treatment methods were effective regarding pain and grip strength; however, P improved the hand functions more significantly.

Brain microstructural changes and cognitive function in non-demented essential tremor patients: a diffusion tensor imaging study.

BACKGROUND: Essential tremor (ET) is disease with both motor and non-motor features. Notable among the non-motor features is cognitive impairment. While this impairment has been attributed to cortico-thalamo-cerebellar pathway pathology, it is likely that a more complicated involvement of brain structures underlies cognitive function in ET. OBJECTIVE: To evaluate the brain microstructural changes of both white matter and grey matter in ET using region of interest based diffusion tensor imaging (DTI), and to correlate these changes with cognitive function assessed during detailed neuropsychological testing. METHOD: Thirty-five non-demented ET patients with a range of cognitive function (Clinical Dementia Rating = 0-0.5, mean age = 57.5 ± 16.7 years, age range = 23-76 years) underwent a comprehensive neuropsychological evaluation and brain magnetic resonance imaging, including DTI. DTI findings were reported as fractional anisotropy, average diffusion coefficient, these values were evaluated for 32 ROIs. Cognitive domains included attention, visuospatial functions, executive function, verbal memory, visual memory, and language. Domain Z-scores were calculated each cognitive domain and compared for each brain region. RESULTS: Microstructural changes in prefrontal cortical areas (dorsolateral, ventrolateral), paralimbic and limbic structures (posterior cingulate cortex, precuneus, hippocampus), basal ganglia (substantia nigra, putamen, caudate nucleus) and white matter bundles (corpus callosum, anterior thalamic radiation, longitudinal fasciculus, frontooccipital fasciculus, etc.) correlated with specific domains of cognitive function in ET patients. CONCLUSION: These data suggest that not only the cerebello thalamocortical pathway, but numerous other brain structures are related to level of cognitive performance and possibly underlie cognitive dysfunction in ET.

Disease activity, handgrip strengths, and hand dexterity in patients with rheumatoid arthritis.

Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting the hand joints and leading to impairment in hand functions. Evaluation of functional impairment is necessary for assessing patient's quality of life, disease activity, and treatment outcome. To date, many scientific studies assessed the disease activity of patients with RA, but little attention has been carried out to assess these patients' hand functions and dexterity. The purposes of this study were to determine the clinical relevance of the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), hand dexterity with the Purdue Pegboard Test (PPT), and handgrip strength and pinch strengths of RA patients and to look into their relation between each other. A prospective trial was performed in women with RA who were followed at the physical medicine and rehabilitation department of our university hospital. Eighty-two women between the ages of 18 and 70, with a diagnosis of RA according to the 2010 American College of Rheumatology/the European League Against Rheumatism (ACR/EULAR) criterion, were recruited to the study. The Disease Activity Scores were determined by using Disease Activity Score-28 (DAS-28). Handgrip strength was measured with a Jamar dynamometer, and lateral, palmar, and tip pinch strengths were measured by a pinchmeter. Hand functions were evaluated with the PPT, and functional outcomes were assessed with the QuickDASH questionnaire. The mean age of the study group was 49.27 ± 10.69 years. The average values of DAS-28 and the QuickDASH values were found to be 4.22 ± 1.28 and 38.33 ± 19.78, consecutively. High correlation was observed between DAS-28 and the QuickDASH values (p < 0.001). The mean grip strengths in both hands were significantly correlated with the QuickDASH values (p < 0.001), and also, DAS-28 values were very significantly correlated with the mean grip strength in the dominant hand (p < 0.001) and in the nondominant hand (p < 0.01). The mean lateral pinch strengths in both hands were correlated statistically significantly with DAS-28 and the QuickDASH scores (p < 0.001). The mean tip pinch strengths in both hands were correlated with DAS-28 scores, but correlation with the QuickDASH scores was seen just in the dominant hand (p < 0.05). There was no correlation between palmar pinch strengths in both hands with the DAS-28 and QuickDASH scores (p > 0.05). DAS-28 was correlated with PPT performance on the dominant hand (p < 0.05), but there was no correlation with the nondominant hand, both hands, and assembly (p > 0.05). The QuickDASH values were not correlated with all PPT performances (p > 0.05). Handgrip strengths of both hands were positively correlated with the PPT performances (p < 0.05). In conclusion, we determined that handgrip strengths were significantly related to disability and disease activity in the RA patients in our study. The QuickDASH is practical to use in clinical practice, and positively correlates with the disease activity. Dexterity measurements with PPT in the RA patient group were found practical and effective in our study. As a result, we can suggest using QuickDASH questionnaire for functional outcomes, handgrip strength measurements for assessment of hand disability and functional impairments, and also dexterity measurements even in patients with low disease activity.

Investigation of Bisphenol A as an endocrine disruptor, total thiol, malondialdehyde, and C-reactive protein levels in chronic obstructive pulmonary disease.

OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is a common health problem and it is associated with oxidant/antioxidant imbalance and systemic inflammation. Bisphenol A (BPA) is an endocrine disruptor agent, exerting a wide variety of metabolic effects. Also, BPA is related with oxidative stress, decreased antioxidant enzymes, and inflammation. The aim of this study is to investigate the relationships between COPD and serum BPA, C-reactive protein (CRP), malondialdehyde (MDA), and total thiol levels. PATIENTS AND METHODS: This study was enrolled at 83 subjects that they were divided into two groups: control (n=33), COPD (n=50). The serum BPA, CRP, MDA, and total thiol levels were analyzed. RESULTS: The CRP and BPA levels were significantly higher in the COPD patients than control subjects. The total thiol levels were significantly lower in COPD cases than the controls. There is no different between groups for MDA. Also, there had a linear relationship between BPA and CRP in correlation analysis. CONCLUSIONS: COPD is associated with high serum BPA, CRP and low total thiol levels in comparison with healthy individuals. It is suggested that BPA might have a role in the etiopathogenesis of COPD.

Diffuse osteosclerosis in a patient with prostate cancer.

A 61-year-old man was referred to our outpatient clinic because of severe bilateral upper leg pain for 1 year. On admission, the patient had anemia and a high serum alkaline phosphatase level. Lumbar and femoral neck T-scores were +10.5 and +9.6, respectively. His radius 33 % T-score was -2.8. Plain radiographs of the patient's pelvis, spine, and long bones revealed osteosclerosis. The patient had previously undergone a prostate biopsy, which showed prostate adenocarcinoma (Gleason score 3 + 4). The patient's total and free prostate-specific antigen were very high. According to previous records, the patient did not have anemia, and his serum alkaline phosphatase (ALP) level was normal. An abdominal radiograph taken 2 years earlier revealed a normal spine and pelvic bone. Bone scintigraphy yielded nontypical findings for prostate cancer metastasis. Computed tomography of the patient's thorax and abdomen showed heterogeneous sclerotic areas in all bones consistent with prostate cancer metastasis. A bone marrow biopsy disclosed disseminated carcinomatosis of bone marrow in association with prostate cancer. Clinicians should be aware of the possibility of prostate malignancy as a cause of high bone mineral density (BMD), even in the absence of typical localized findings on plain radiographs.

Evaluation of carotid intima media thickness in impaired fasting glucose and impaired glucose tolerance.

AIM: Increased carotid intima media thickness (CIMT) is recognized as the early indicator of atherosclerosis. We aimed to evaluate the effect of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) on the CIMT. METHODS: We evaluated 51 dysglycemic patients (IFG [N.=22]; IGT [N.=29]) and 25 controls who have similar age and gender. Patients who were known to have coronary heart disease, cerebrovascular disease, hypertension, hyperlipidemia, diabetes mellitus and hypo-hyperthyrodism were excluded. We measured fasting blood glucose (FBG), postprandial blood glucose (PPG), insulin, insulin resistance, lipid profile, hsCRP, microalbuminuria, and glycosylated hemoglobin A1c (HbA1c). We measured the CIMT by Doppler ultrasonography. RESULTS: Both IFG and IGT patients have increased CIMT according to controls (P<0.001). Mean CIMT of IFG, IGT and control were 0.704, 0.738 and 0.555 respectively. There were no differences in point of fasting insulin and HOMA-IR between IFG and IGT. There were positive correlation of CIMT and FBG, PPG, HbA1c, fasting insulin and HOMA-IR in both groups. In linear regression analysis, PPG and HbA1c is the major factor affecting CIMT (t=0.017 and 0.036). CONCLUSION: IFG and IGT have increased CIMT according to controls, and PPG and HbA1c are the major affecting factors to CIMT.