Neuropathic pain in patients with post-COVID-19.

OBJECTIVE: In this study, we aimed to determine the continuing pain during the post-COVID-19 period the frequency of neuropathic pain in these patients, and the factors affecting the frequency. METHODS: A total of 209 participants were included in the study who had COVID-19 disease (PCR-positive) aged 18-75 years. The demographic characteristics and COVID-19 severity data were recorded by questioning the patients. The musculoskeletal pain was also assessed using Visual Analog Scale (VAS) and the extended Nordic musculoskeletal system questionnaire (NMQ-E). In addition, the neuropathic components of pain were evaluated using the Leeds Assessment of neuropathic symptoms and Signs (LANSS) pain scale and the Pain-DETECT questionnaire (PDQ). RESULTS: The mean time elapsed since COVID-19 was 5.76±2.95 months (min, 1; max, 12). Six patients (2.9%) had neuropathic pain according to the LANSS score, and 12 patients (5.7%) according to the PDQ score. The NMQ-E indicated that the most pain was detected in the back (20.1%), low back (15.3%), and knee (11.5%) regions during the post-COVID-19 period. According to both neuropathic pain scales; low back pain (p=0.001/0.001) and knee pain (p=0.001/0.01) were more common in patients with PDQ/LANSS neuropathic pain. Logistic regression analysis showed that there were significant associations between neuropathic pain and acute COVID-19 VAS score. CONCLUSION: This study demonstrated that musculoskeletal pain was prominent mostly in the back, low back, and knee during the post-COVID-19 period. The incidence of neuropathic pain was 2.9%-5.7% depending on the evaluation parameters. Neuropathic pain is a finding that should be considered during the post-COVID-19 period.

The relationship between motor performance and femoral cartilage thickness in children with Down syndrome.

Down syndrome (DS) is a genetic disorder associated with mental and motor developmental delays in childhood. The aim of this study was to investigate the relationship of the femoral cartilage thickness with motor performance in children with Down syndrome (DS). A total of 39 children with DS in the age range of 12-42 months were included in the study (female/male: 21/18; mean age: 23.4 ± 8.2 months). Femoral cartilage thickness was measured with ultrasound in the medial and lateral condyles and intercondylar areas of both knees. Gross motor subtest scaled scores of the Bayley Scales of Infant and Toddler Development III were used for the motor performance assessment. There was a positive correlation between the gross motor scaled scores and the femoral cartilage thickness in both knee joints (p < .05; r = 0.415 for the right medial condyle; r = 0.323 for the right lateral condyle; r = 0.339 for the right intercondylar area; r = 0.369 for the left medial condyle; r = 0.364 for the left lateral condyle, and r = 0.590 for the left intercondylar area). The study demonstrated that the femoral cartilage thickness was positively correlated with gross motor functioning in children with DS.

Impacts of combined osteopenia/osteoporosis and sarcopenia on balance and quality of life in older adults.

OBJECTIVE: Combined osteopenia/osteoporosis and sarcopenia is a major public health problem for old adults. In this study, we aimed to evaluate the impacts of combined osteopenia/osteoporosis with sarcopenia on balance and quality of life in patients older than 65 years. METHODS: In this sudy, 77 patients with sarcopenia, who were older than 65 years, were included. The diagnosis of sarcopenia was made according to the diagnostic criteria developed by The European Working Group on Sarcopenia in Older People (EWGSOP). Bone densitometry was performed to screen for osteoporosis or osteopenia. The balance was assessed with the anterior-posterior stability index (APSI), medial-lateral stability index (MLSI), and the general stability index (OSI), which were calculated using a Biodex Stability System device (BSS). The quality of life was assessed using SF-36. RESULTS: Patients with sarcopenia were included in this study. Of them, 40 had osteoporosis and 37 had osteopenia. The measures of balance and the OSI, APSI, and MLSI values were low in both groups of patients, but they were statistically significantly lower in the sarcopenia with osteoporosis group compared to the sarcopenia with osteopenia group (p=0.01; p=0.002; p=0.04, respectively). The quality of life was lower in all sub-categories of SF-36, excluding the mental health when sarcopenia was accompanied by osteoporosis compared to the joint occurrence of sarcopenia with osteopenia (p<0.05). CONCLUSION: Our study suggests that the joint occurrence of osteoporosis with sarcopenia is associated with a risk of balance loss, a decrease in quality of life, and a potentially increased fracture risk in older adults.

Median nerve ultrasound in carpal tunnel syndrome with normal electrodiagnostic tests.

INTRODUCTION: To evaluate the ultrasound findings of the median nerve in patients with clinical assigned carpal tunnel syndrome but normal nerve conduction studies. METHODS: This prospective, cross-sectional study involved 41 patients (51 hands) with clinically assigned CTS and normal nerve conduction studies and 20 healthy controls (30 hands). Ultrasonography was performed in all participants, and cross-sectional area (CSA), hypoechogenicity, and mobility of the median nerve were evaluated. All patients were assessed with Boston Carpal Tunnel Questionnaire (BCTQ). RESULTS: CSA of the median nerve in the wrist was significantly higher in the patient group when compared to the control group. Echogenicity and mobility were significantly decreased in the patient group. Ultrasound abnormalities were positively correlated with clinical features. A significant correlation was observed among sensory loss, provocative tests, body mass index, BCTQ, and high CSA. CONCLUSION: US can help the clinicians with the diagnosis of carpal tunnel syndrome in patients with clinical symptoms but negative nerve conduction study results.

Determining the spiritual well-being of patients with spinal cord injury.

Context/Objective: The present study was designed to determine the spiritual belief levels of patients with spinal cord injury as well as to examine the socio-demographic factors that affect their spiritual beliefs.Design: This study was designed as a descriptive study.Setting: The physical therapy and rehabilitation unit of a city Education and Research hospital.Participants: All patients over the age of 18 years who have had spinal cord injuries.Outcome Measures: Data for the study were collected using a questionnaire and the FACIT-Spiritual Well-Being Scale.Results: People with SCI in the eastern region of Turkey demonstrate moderately high levels of spiritual well-being. A significant correlation was identified between socio-demographic characteristics, such as age, marital status, level of income, status of receiving care, and duration of diagnosis, and the spiritual well-being of patients with spinal cord injury. While previous studies have been conducted in Christian communities, the current study was the first to be conducted in a Turkish (primarily Muslim) community. Therefore, the current study will significantly contribute to the literature an explanation of the spiritual well-being of patients with spinal cord injuries in Muslim communities.Conclusions: Degree of spiritual well-being in Turkey is similar to other regions studied to date. Spiritual well-being is important in coping with the physical, social, economic, and emotional problems experienced by patients after a spinal cord injury. Healthcare professionals are encouraged to support the spiritual needs of their patients.

The effects of depression, personal characteristics, and some habits on physical activity in the elderly.

PURPOSE: The current study investigated the effects of depression, personal characteristics, and some habits on physical activity levels among the elderly. DESIGN AND METHODS: This study followed a descriptive design. The population of the study consisted of 11 750 individuals at least 65 years old. The sample size of the study was determined to be 967 by power analysis. Descriptive statistics and logistic models were used for data analysis. RESULTS: Together, age, the presence of a caregiver, chronic disease, and the Geriatric Depression Scale (GDS) score explained 32% of the variance in the physical activity of the elderly. Among these factors, the GDS score alone had the greatest effect. PRACTICAL IMPLICATIONS: To maintain health, it is important to reduce depression and increase physical activity among the elderly.

Comparison of blood platelet distribution width and neutrophil-lymphocyte ratio in patients with different grades of knee osteoarthritis.

OBJECTIVE: The aim of this study was to compare platelet distribution width (PDW) and neutrophil to lymphocyte ratio (NLR) values in mild-to-moderate and severe knee osteoarthritis (OA). METHODS: This was a retrospective study of patients with knee OA according to the Kellgren-Lawrence (KL) grading system. Of 465 patients, 231 were excluded (62 due to not meeting the inclusion criteria and 169 due to the lack of simultaneous haemogram and radiographic evaluations). Demographic characteristics and PDW and NLR values were recorded. The patients were then divided into two groups: KL grade 1-3 (mild-to-moderate OA) and KL grade 4 (severe OA). RESULTS: In severe knee OA patients, blood PDW (13.44 ± 2.58, p= 0.01) and NLR values (2.16 ± 0.84, p= 0.04) were elevated as compared with those in mild-to-moderate knee OA patients. Blood PDW and NLR values of ⩾ 12.5 and ⩾ 2.1, respectively, were taken as cut-offs based on a receiver operating characteristics (ROC) curve analysis. In the ROC curve analysis, blood NLR ⩾ 2.1 had 60% sensitivity and 64.8% specificity, and PDW ⩾ 12.5 had 61% sensitivity and 58% specificity in predicting severe knee OA. In a univariate analysis, age (p< 0.001), PDW ⩾ 12.5 (p= 0.029) and blood NLR ⩾ 2.1 (p= 0.030) emerged as significant predictors of the severe knee OA. CONCLUSION: The results suggested that the blood PDW and NLR are novel inflammatory markers that can predict the radiographic severity of knee OA in clinical practice.

Comparison of high-intensity laser therapy and combination of transcutaneous nerve stimulation and ultrasound treatment in patients with chronic lumbar radiculopathy: A randomized single-blind study.

OBJECTIVE: To compare the effects of high-intensity laser therapy (HILT) and a combination of transcutaneous nerve stimulation (TENS) with ultrasound (US) therapy on pain and functionality in patients with chronic lumbar radiculopathy. METHODS: This prospective randomized comparative study was conducted in Department of physical medicine and rehabilitation, Turgut Ozal Medicine Center, Malatya, Turkey from April 2016 to September 2016. A total of 54 patients with chronic lumbar radiculopathy were enrolled in this study. The patients were randomly divided into two groups: Group 1 (n:27) received 10 sessions of a combination of hot pack, TENS, US and exercise, and Group 2 (n:27) received hot pack, HILT and exercise. The outcomes measured were low back with unilateral leg pain level measured by visual analog scale (VAS) and functionality measured with the Oswestry Disability Index (ODI) at the end of the therapy and four weeks later. p-value less than 0.05 considered statistically significant. RESULTS: In two groups, VAS (low back with unilateral leg pain) and ODI scores showed significant changes. At the end of the 2 weeks intervention, participants in Group-1 showed a significantly greater decrease in pain than participants in Group-2. Statistically significant differences in pain variation and functionality (VAS and ODI) were observed four weeks after treatment sessions for participants in the TENS+US therapy group compared with participants in the HILT group. CONCLUSION: HILT and TENS+US combined with exercise were effective treatment modalities in decreasing the VAS and ODI scores. TENS+US combined with exercises were more effective than HILT combined with exercise.

Comparison of splinting and Kinesio taping in the treatment of carpal tunnel syndrome: a prospective randomized study.

The aim of this study was to investigate and compare the effectiveness of splinting and Kinesio taping (KT) as forms of treatment for patients with mild to moderate idiopathic carpal tunnel syndrome (CTS) by evaluating the symptoms and measuring the range of function and electrophysiological findings. This single-blind, randomized, prospective study included 44 patients (58 hands) suffering mild to moderate idiopathic CTS according to nerve conduction studies (NCS). The patients were randomized into two groups and evaluated before treatment and 6 weeks after treatment by means of physical examination findings, NCS, and the Boston Carpal Tunnel Questionnaire (BCTQ) functional status and symptom severity scale scores. When the differences in both groups before and after treatment were compared, a significant improvement was observed in the KT group compared to the splint group in terms of electrophysiological changes, provocative test responses, BCTQ symptom severity, and functional status scores. KT may help prevent the disease from progressing further in mild and moderate idiopathic CTS when applied in time using the appropriate technique and be a good alternative to neutral splinting in terms of patient compliance.

Functional outcomes following ultrasound-guided botulinum toxin type A injections to reduce spastic equinovarus in adult post-stroke patients.

OBJECTIVE: The aim of this study is to identify the effect on spasticity and walking of US-guided botulinum toxin type A (BoNT-A) injections administered to improve equinovarus walking pattern commonly observed in patients after stroke. MATERIAL AND METHOD: Twenty-three patients with post-stroke spastic equinovarus deformity were recruited. The US-guided BoNT-A injections were administered into the spastic muscles (including gastrocnemius; GK, soleus; S and tibialis posterior; TP) using a specific approach, and all of the patients were enrolled in rehabilitation programmes after the injections. Modified Ashworth Scale (MAS), Brunnstrom stage of lower limb, Functional Ambulation Score (FAS), Preferred Gait Speed (PGS) and the six-minute walk test (6MWT) were assessed at the baseline, 4 and 12 weeks after the BoNT-A injection. RESULTS: Significant decreases in the MAS scores of the lower limb muscle (GK, S and TP) tone were measured 4 and 12 weeks after the BoNT-A injection when compared to the baseline scores (p < 0.05). In parallel with a reduction in spasticity there was an increase in 6MWT and PGS in the 4th and 12th weeks. Increases in motor improvement and functional ambulation score were ensured in the 12th week (p < 0.05). CONCLUSION: Spastic equinovarus deformity observed in patients after stroke creates significant limitations in the patient's functional walking speed and distance. As a result, when BoNT-A injections accompanied by ultrasound to improve equinovarus deformity considering the innervation zones of the muscles with a specific approach are administered directly into the muscle at the correct point, we can say it provides hopeful results from a functional point of view.

Comparision of the effectiveness of ESWT and ultrasound treatments in myofascial pain syndrome: randomized, sham-controlled study.

[Purpose] The purpose of this study is to compare effectiveness of extracorporeal shock wave therapy (ESWT), ultrasound (US) and sham ESWT in the treatment of myofascial pain syndrome (MPS). [Subjects and Methods] Sixty MPS patients aged 18-60 years were included in the study. The patients were randomized equally into 3 groups. Group 1 received ESWT for 4 session with 3 day-intervals. Group 2 received 4 sessions of sham ESWT. US was applied to Group 3 for 10 sessions. All patients were recommended an exercise program. The patients were evaluated before-post and 6 weeks after treatment. Measurements were made using pressure pain threshold (PPT), pain score (PS) and visual analogue scale (VAS). Patients were evaluated by using SF-36 and HADS (hospital anxiety and depression scale). [Results] A significant posttreatment difference was found in VAS, PPT and SF-36 subparameters in group 1. In group 2, a significant difference was not found in any parameter. In group 3, a significant difference was detected in parameters of VAS and PPT. A significant difference was found between groups 1 and 2 as for subtitles of PPT, VAS, SF-36. [Conclusion] These results suggest that ESWT is as effective as US. ESWT and US are significantly more effective than sham ESWT.

Evaluating the functional outcomes of ultrasound-guided botulinum toxin type A injections using the Euro-musculus approach for upper limb spasticity treatment in post-stroke patients: an observational study.

BACKGROUND: Ultrasound-guided botulinum toxin type A injection is an effective treatment for spasticity. Euro-musculus spasticity approach is a new method for administering injections to the correct point of the correct muscle. The clinical outcomes of this practical approach are not yet available in the literature. AIM: The purpose of this study was to evaluate the effects on spasticity and the functional outcomes of ultrasound guided botulinum toxin type A injections via the Euro-musculus spasticity approach to treat upper limb spasticity in post-stroke patients. DESIGN: Observational study. SETTING: Inpatient post-stroke patients. POPULATION: Twenty-five post-stroke patients with post-stroke upper limb spasticity were recruited. METHODS: The ultrasound-guided botulinum toxin type A injections were administered into the spastic target muscles using the Euro-musculus spasticity approach, and all of the patients were enrolled in rehabilitation programs after the injections. This research included the innervation zone and injection site figures and ultrasound images of each muscle in the upper limb. The degree of spasticity was assessed via the Modified Ashworth Scale and the upper limb motor function via the Fugl Meyer Upper Extremity Scale at the baseline and 4 and 12 weeks after the botulinum toxin type A injection. RESULTS: Significant decreases in the Modified Ashworth Scale scores of the upper limb flexor muscle tone measured 4 and 12 weeks after the botulinum toxin type A injection were found when compared to the baseline scores (P<0.025). When compared with the baseline Fugl Meyer Upper Extremity subgroup scores, the sitting position, wrist and total scores at 4 and 12 weeks were significantly improved (P<0.025). However, only the Fugl Meyer Upper Extremity hand scores were significantly improved 12 weeks after the injection (P<0.025). CONCLUSIONS: Ultrasound-guided botulinum toxin type A injection via the Euro-musculus spasticity approach is a practical and effective method for administering injections to the correct point of the correct muscle. Ultrasound-guided botulinum toxin type A injections combined with rehabilitation programs decrease spasticity and improve the upper extremity motor functions in stroke patients. CLINICAL REHABILITATION IMPACT: This new approach for ultrasound-guided botulinum toxin type A injection is very practical and effective method for upper extremity spasticity.

A comparison of the effectiveness of amitriptilin and pregabalin treatment in fibromyalgia patients.

OBJECTIVE: The present study is a comparison of the effectiveness of amitriptyline and pregabalin on the symptoms of fibromyalgia patients. METHODS: A total of 71 female patients aged ≥18 years were included in this study. The patients were divided into 2 groups. Pregabalin (n=36) or amitriptyline (n=35) treatment was initiated at daily oral dose of 450 mg and 25 mg, respectively for the indicated number of patients. The patients were evaluated at the start of treatment and at the end of 12 weeks. The Fibromyalgia Impact Questionnaire, Fatigue Severity Scale, Modified Fatigue Impact Scale, Hospital Anxiety Depression Scale, Nottingham Health Profile, Mini Mental State Test, and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) were administered to all study participants. Pain at all tender points was measured using a pressure algometer. RESULTS: Significant improvement was observed in both groups after 12 weeks of treatment (p<0.05). Percent change in LANSS was greater in the pregabalin group compared with the amitriptyline group. Tender point pressure pain thresholds and total myalgic score improved significantly in both groups (p<0.05); however higher percentage change in these parameters was achieved in the amitriptyline group when compared with the pregabalin group (p<0.05). CONCLUSION: Both drugs improved pain, fatigue, sleep disorder, disability, psychological evaluation, and cognitive function; however, amitriptyline was more effective at reducing experimentally measured pain than neuropathic pain. According to these results, preference for pregabalin may be recommended in fibromyalgia patients whose primary complaint is neuropathic pain.

Evaluation of blood neutrophil-lymphocyte ratio and platelet distribution width as inflammatory markers in patients with fibromyalgia.

Fibromyalgia syndrome (FMS) is characterized by chronic widespread pain and systemic symptoms. The aetiology and pathogenesis of fibromyalgia are not yet fully understood. Blood neutrophil/lymphocyte ratio (NLR) is a marker of systemic inflammatory response. Platelet distribution width (PDW) and mean platelet volume (MPV) are the determinants of platelet activation and studied as markers in inflammatory diseases. The aim of the present study was to evaluate levels of NLR,PDW and MPV in patients with fibromyalgia. A total of 197 FMS patients and 53 healthy controls are included in the study. Demographic characteristics, erythrocyte sedimentation rate, C-reactive protein, neutrophil, lymphocyte and platelet counts, platelet distribution width and mean platelet volume levels were recorded. In the patient group, the blood NLR and MPV were significantly higher and the PDW was significantly lower compared to the control group. In the roc curve analysis, blood PDW ≥had 90.4% sensitivity and 90% specificity in predicting fibromyalgia. The results of this study suggest NLR and PDW as promising inflammatory markers indicating fibromyalgia and may be beneficial in facilitating the diagnosis of FMS patients.

Association between serum total antioxidant status and flow-mediated dilation in patients with systemic lupus erythematosus: an observational study.

OBJECTIVE: Endothelial dysfunction (ED) is a condition that involves increased oxidative stress and decreased total antioxidant status (TAS) levels. Systemic lupus erythematosus (SLE) is also associated with ED. We aimed to determine the association between serum TAS and ED as assessed by flow-mediated dilation (FMD) in patients with SLE. METHODS: Thirty-four patients with stable SLE who were not undergoing any treatment and 39 healthy volunteers without any overt cardiovascular disease were included in this cross-sectional study. Doppler ultrasound was used to measure FMD to assess ED in the study groups. Serum TAS levels were measured using a TAS kit. High-sensitivity C-reactive protein (hs-CRP) and anticardiolipin antibody (aCLA) levels were also measured to assess the inflammatory state. The SLE group further was divided into 2 groups according to presence or absence of aCLA. SLE disease activity was assessed using the SLE disease activity index (SLEDAI). Regression analysis was used to define independent predictors. RESULTS: The mean TAS levels were significantly lower in patients with SLE than in controls (1.60±0.11 versus 1.73±0.15 mmol/L, p<0.001). hs-CRP levels were significantly higher in patients with SLE than in controls (8.2±6.0 vs. 2.9±4.0 mg/L; p<0.001), particularly in SLE patients with positive aCLA when compared with SLE patients with negative aCLA (13.8±4.3 vs. 5.6±4.8 mg/L, p<0.001). The FMD percent was significantly lower in patients with SLE than in controls (8.1±4.9 vs. 10.6±4.7, p=0.04). There was a significant positive correlation between FMD and TAS in the SLE group (r=0.448, p=0.008) and the control group (r=0.367, p=0.03) and a significant negative correlation between FMD and serum hs-CRP (r=-0.368, p=0.04) in only the SLE group. In multiple linear regression analysis, TAS, hs-CRP, and SLEDAI were independently correlated with FMD (ß=0.50, p=0.003; ß=-0.33, p=0.03; and ß=-0.36, p=0.03; respectively). CONCLUSION: Patients with SLE who have no overt cardiovascular disease are at increased risk for ED and this may be associated with underlying inflammation and impairment of TAS.

Left atrial volume and function in patients with Behcet's disease assessed by real-time three-dimensional echocardiography.

AIMS: Behçet's disease (BD), a multisystemic inflammatory disorder, has been associated with a number of cardiovascular dysfunctions, including endomyocardial fibrosis of the right heart, atrial fibrillation, ventricular arrhythmias and sudden cardiac death. The incidence and nature of cardiac involvement in BD are not yet clearly documented. Our aim was to evaluate left atrial (LA) volume and functions using real-time three-dimensional echocardiography (RT3DE) in Behcet's patients without any cardiac symptom. METHODS AND RESULTS: The study included 40 BD (16 females, 24 males and mean age of 33±7 years) and 30 healthy (11 females, 19 males and mean age of 35±6 years) subjects. All the patients' demographic parameters such as age, gender, and duration of BD were recorded. All the individuals underwent comprehensive 2D echocardiography examination, and RT3DE was performed to assess LA volumes and mechanical functions. LA maximum volume (Vmax) and before atrial contraction volume (Vpre A), LA active stroke volume and total stroke volumes (TSV), total emptying and active emptying fractions and expansion index were significantly higher in Behcet's disease patients when compared with the controls (P<0.0001 for all). LA passive emptying fraction was significantly lower in the patients with BD than in the controls (41±7 vs. 44±5, P=0.039). There were positive correlations between TSV and high-sensitive C-reactive protein level (r=0.413, P=0.008), TSV, and disease duration (r=0.417, P<0.007). CONCLUSION: Our study has shown that LA mechanical functions and volumes are impaired in BD. These results may be an early form of subclinical cardiac involvement in patients with BD who have no clinical evidence for cardiovascular disease.