SARS-CoV-2 in early pregnancy-does it affect the aneuploidy screening markers and cause pregnancy loss?

BACKGROUND: It is known that vertical transmission of various infections poses a potential risk to the fetus, especially in early pregnancy. Potential effects of SARS-CoV-2 infection on early pregnancy and placental formation and functions still remain unknown. AIM: To determine the alterations of prenatal aneuploidy screening markers in a group of pregnant women who were SARS-CoV-2 positive during the first trimester. The secondary goal was to assess pregnancy loss rates. METHOD: The study group consisted of pregnant women who were diagnosed with mild forms of SARS-CoV-2 infection before the screening test at any time in early pregnancy. The control group included pregnant women who were not diagnosed with SARS-CoV-2 infection during their pregnancy. SARS-CoV-2 infection was detected by RT-PCR in the nasopharyngeal swab samples. Multivariate linear regression analysis was performed due to evaluate effect of SARS-CoV-2 infection on NT and serum aneuploidy screening parameters taking maternal age and gestational age which the COVID-19 RT-PCR test result was positive into account. RESULTS: We did not find any significant difference between the COVID-19-positive and COVID-negative groups in gestational age at screening, sonographic measurements of CRL, NT, and serum levels of PAPP-A, free hCG, and triple test serum markers even after accounting for maternal age and gestational age which the COVID-19 RT-PCR test result was positive. There was no statistically significant difference in pregnancy loss. CONCLUSIONS: We did not find any evidence for unfavorable prenatal biochemical, ultrasound markers of fetal aneuploidy screening tests, and pregnancy loss rates in our study group.

Investigation of maternal serum hepassocin concentrations in pregnant women with gestational diabetes mellitus: a prospective case-control study.

OBJECTIVE: We aimed to investigate the relationship between gestational diabetes mellitus (GDM) and maternal serum hepassocin concentrations. MATERIALS AND METHODS: This cross-sectional study was conducted with 88 pregnant women who applied to the Ümraniye Training and Research Hospital Gynecology and Obstetrics Clinic between April 2022 and November 2022. The GDM group consisted of 44 pregnant women who had a 75-g OGTT between the 24th and 28th week of pregnancy and were diagnosed with GDM. The control group consisted of 44 healthy pregnant women who were matched with the GDM group in terms of age and body mass index (BMI) and had a normal 75-g OGTT result. Demographic characteristics, laboratory findings, and perinatal outcomes were noted. Two groups were compared in terms of maternal serum hepassocin concentrations. RESULTS: Both groups were similar in terms of age, BMI, weight gain, gravida, parity, polycystic ovary syndrome history, history of diabetes mellitus in the family, and the gestational week at blood sampling for hepassocin (p>0.05 for each). The median maternal serum hepassocin concentration was found to be 18.21 ng/ml in the GDM group, while it was determined as 13.05 ng/ml in the non-GDM group (p=0.012). The GDM group was divided into two groups: the group that only dieted until birth and the group that used insulin until birth for blood glucose regulation. The median hepassocin concentration was found to be 17.99 ng/ml in the diet-only GDM group and 32.15 ng/ml in the insulin-using GDM group. ROC analysis was performed to determine the value of maternal serum hepassocin concentration in predicting GDM. AUC analysis of maternal serum hepassocin for estimation of GDM was 0.656 (p=0.012, 95% CI=0.53-0.77). The optimal threshold value for maternal serum hepassocin concentration was determined as 14.13 ng/ml with 61.4% sensitivity and 61.4% specificity. CONCLUSION: Serum hepassocin concentration evaluated between 24 and 28 weeks of gestation was found to be higher in pregnant women with GDM than in the non-GDM group. The highest serum hepassocin concentration was found in the GDM group using insulin for blood glucose regulation. Hepassocin seems to be a promising molecule that can be used in GDM screening in pregnant women who do not want to have an OGTT in the future.

The effect of advanced maternal age on perinatal outcomes in nulliparous pregnancies.

OBJECTIVES: In the current study, we aimed to evaluate the effect of advanced maternal age on perinatal outcomes in nulliparous singleton pregnancy. METHODS: The perinatal outcome data of 11,366 patients who gave birth between 2015 and 2020 were evaluated retrospectively. Patients were subgrouped according to their age as control group (C) (20-29 years), late advanced maternal age group (30-34 years), advanced maternal age group (35-39 years), and very advanced maternal age group (≥40 years). Multinomial logistic regression analyses were performed to test the possible independent role of maternal age as a risk factor for adverse pregnancy outcomes. RESULTS: Statistically significant difference was observed between the control group and the other groups in terms of preterm delivery, preeclampsia, gestational diabetes mellitus (GDM), small gestational age (SGA), large gestational age (LGA), premature rupture of membranes (PROM), high birth weight (HBW), and perinatal mortality rates (p<0.05). An increased risk of the need for neonatal intensive care unit (NICU) and perinatal mortality was observed in groups over 35 years old. CONCLUSIONS: Age poses a risk in terms of preterm delivery, preeclampsia, LGA, GDM, and HBW in the groups over 30 years of maternal age. The rates of PROM, NICU, and perinatal mortality increase in addition to those perinatal results in the groups above 35 years of maternal age.

Evaluation of sympathetic response in cases with failed back surgery syndrome.

OBJECTIVES: The aim of this study was to investigate whether sympathetic skin response (SSR) was affected in cases with failed back surgery syndrome (FBSS). METHODS: Twenty-nine cases admitted to our department and diagnosed as FBSS were recruited for the study. All the cases had back, leg or back and leg pain in the months or in one year following spinal surgery. The control group consisted of 13 healthy hospital personnel. Electrophysiologic nerve conduction studies and SSR recordings were applied on the symptomatic side (29 legs) in study cases and both sides (26 legs) in the control group. SSRs of the study group were compared with those of the sex-, body mass index- and age-matched control group of 13 people. Patients having peripheral nerve entrapment syndromes, peripheral vascular disease, neurologic or psychiatric disease, alcoholism, or drug abuse were excluded from the study. Pain intensity was recorded by visual analog scale (VAS) and depression was recorded by Beck Depression Inventory (BDI). RESULTS: Latency duration in SSR in the study group was significantly higher (p=0.006) when compared with the healthy controls. There was no SSR in 4 patients and there was a positive correlation between BDI and SSR (r=0.46). CONCLUSION: It was concluded that the sympathetic nervous system is affected in FBSS patients with changes in SSR, and that the dysfunction of the sympathetic nervous system may contribute to the intensity and chronicity of pain states in this group of patients.

Demographics features, clinical findings and functional status in a group of subjects with cervical myofascial pain syndrome.

Subjects with myofascial pain of muscles of the neck region may present with various clinical symptoms. The aim of this study was to explore the demographics features, clinical findings and functional status in a group of patients presenting with myofascial pain of the cervical muscles. 94 cervical myofascial pain syndrome patients were recruited from the out-patient clinic. Evaluated of patient short form health survey (SF-36), pain, depression, patient demographics and physical examinations. Outcome measures; SF-36 Health Survey, visual analog scale, Beck Depression Inventory, history, physical examination. A total of 82 patients with a diagnosis of cervical myofascial syndrome were included in the study. All patients were in the young age group 37.4+/-9, and 87.8% were females. 53.1% had trigger points in the trapezius muscle with high percentage of autonomic phenomena like skin reddening, lacrimation, tinnitus and vertigo. 58.5% of the series had suffered from former cervical trauma and 40.2% also had fibromyalgia syndrome and 18.5% had benign Joint hypermobility syndrome. Younger female patients presenting with autonomic phenomena and early onset cervical injury should be examined for cervical myofascial pain syndrome and also for fibromyalgia syndrome since this study demonstrated a high percentage of fibromyalgia syndrome in these patients.

Evaluation of knee proprioception and effects of proprioception exercise in patients with benign joint hypermobility syndrome.

The first aim is to show if there is a disorder in proprioception in cases with benign joint hypermobility syndrome (BJHS) when compared to healthy subjects. The second aim is to evaluate the effect of proprioception exercise in BJHS cases. To evaluate the proprioceptive sensibility of the knee joint with 40 BJHS and 30 healthy subjects enrolled in the study. Then, cases with BJHS were randomized into two groups; proprioceptive exercises were applied to 15 patients for 8 weeks in clinic and 25 patients were taken as controls. Outcome measures included proprioceptive sensation, AIMS2 and VAS. Proprioception is significantly impaired in cases with BJHS. In BJHS group, significant decreases in VAS levels were detected in cases who did exercise compared with cases who did not, and statistically significant improvements were detected in occupational activity. For this reason proprioception exercises cause decrease in pain and improvement of functional status in BJHS group.

[Elongated styloid process (Eagle's syndrome): literature review and a case report]. / Uzamis stiloid proçes (Eagle's sendromu): Olgu sunumu.

Eagle's syndrome occurs when an elongated styloid process or calcified stylohyoid ligament causes recurrent throat pain or foreign body sensation, dysphagia, or facial pain. Additional symptoms may include neck or throat pain with radiation to the ipsilateral ear. The symptoms related to this condition can be confused with those attributed to a wide variety of facial neuralgias. Diagnosis can usually be made on physical examination by digital palpation of the styloid process in the tonsillar fossa. The treatment of Eagle's syndrome is primarily surgical. The styloid process can be shortened through an intraoral or external approach. We report a 51-year-old woman with the symptomatology of Eagle's syndrome and literature review.

Juvenile rheumatoid arthritis: physical therapy and rehabilitation.

Juvenile arthritis is one of the most prevalent chronic diseases in the childhood period (ages 0 to 16 years). This disease was first defined in the first half of the 16th century. In the course of time, its differential diagnosis and characteristics have been determined, and it has been classified. Incidence and prevalence values are 10 to 20 in 100,000 and 56 to 113 in 100,000, respectively. Various factors are suggested for its underlying cause. Its denomination is also in dispute. Treatment of juvenile arthritis includes education, medical treatment, physical therapy, and occupational therapy. This article summarizes the objectives and methods of physical therapy and rehabilitation that are important parts of treatment.

The effectiveness of exercise programmes after lumbar disc surgery: a randomized controlled study.

OBJECTIVE: To compare two different exercise programmes versus a control group, after lumbar disc surgery. DESIGN: A prospective, single-blind, randomized controlled study. SETTING: Outpatient clinic of Istanbul Faculty of Medicine, Department of Physical Medicine and Rehabilitation. SUBJECTS: Sixty patients diagnosed as having single level lumbar disc herniation with clinical examination and MRI evaluation and who had undergone lumbar discectomy (post-operative first month) at a single level. Patients with serious pathologies involving the cardiac and respiratory systems that could prevent them from doing exercises were excluded. INTERVENTION: The patients were randomly split into three groups. The first group received an intensive exercise programme and back school education while the second group received a home exercise programme and back school education. The third group was defined as the control group and did not receive education or exercise. MAIN MEASURES: The patients were evaluated at the beginning and end of the treatment with clinical parameters, pain levels, endurance tests and weight-lifting tests, modified Oswestry Disability Index, Beck Depression Inventory, Low Back Pain Rating Scale and return to work. RESULTS: The groups doing exercises experienced a decrease in the severity of pain and disability, also functional parameters showed better improvement than the control group. The intensive exercise programme was better than the home exercise programme. CONCLUSIONS: It seems that intensive exercise is more effective in reduction of pain and disability, but whether it is cost-effective is not clear.

Comparison of laser, dry needling, and placebo laser treatments in myofascial pain syndrome.

OBJECTIVE: We aimed to evaluate the effectiveness of laser therapy in myofascial pain syndrome treatment. BACKGROUND DATA: Myofascial pain syndrome is a disease that is characterized by hypersensitive points called trigger points found in one or more muscles and/or connective tissues. It can cause pain, muscle spasm, sensitivity, stiffness, weakness, limitation of range of motion and rarely autonomic dysfunction. Physical therapy modalities and exercise are used in the treatment of this frequently encountered disease. METHODS: The placebo controlled, prospective, long-term follow up study was planned with 60 patients who had trigger points in their upper trapezius muscles. The patients were divided into three groups randomly. Stretching exercises were taught to each group and they were asked to exercise at home. Treatment duration was 4 weeks. Placebo laser was applied to group 1, dry needling to group 2 and laser to group 3. He-Ne laser was applied to three trigger points in the upper trapezius muscles on both sides with 632.8 nm. The patients were assessed at before, post-treatment, and 6 months after-treatment for pain, cervical range of motion and functional status. RESULTS: We observed a significant decrease in pain at rest, at activity, and increase in pain threshold in the laser group compared to other groups. Improvement according to Nottingham Health Profile gave the superiority of the laser treatment. However, those differences among the groups were not observed at 6-month follow up. CONCLUSIONS: Laser therapy could be useful as a treatment modality in myofascial pain syndrome because of its noninvasiveness, ease, and short-term application.

The frequency and associated factors of low back pain among a younger population in Turkey.

STUDY DESIGN: Open design cross-sectional questionnaire. OBJECTIVES: The aims of this study are to determine the frequency of low back pains in the younger population and the factors that have an influence on this frequency. SUMMARY OF BACKGROUND DATA: Low back pain is one of the most important social problems that causes injuries in the younger population. Low back pain frequency is around 30% among adolescents, and 88% of those with low back pain experiences in adolescence have low back pain in later years. Therefore, identifying and, if possible, preventing the associated factors in adolescence and young adulthood is essential for the solution of this social problem. METHODS: A total of 1,552 students from a total of 8,000 who had come from all parts of Turkey for university registration accepted to participate in the study and were given a questionnaire about low back pain experiences, disability, and possible associated factors. RESULTS: Low back pain frequency was found to be 40.9%. This rate increases with age. Abandonment of moderate level physical activity and traumas such as slipping on ice and falling down the stairs were identified as associated factors. CONCLUSIONS: Regular physical activity and the prevention of falls might be ways for decreasing the frequency of low back pain experiences among the youth and significantly influencing the frequency of low back pain in adult population.

Change of quadriceps angle values with age and activity.

OBJECTIVE: The lines connecting the anterior superior iliac spine to the center of the patella and the center of the patella to the tibial tuberosity make the quadriceps angle (Q angle), and this can be used as data for patellar alignment. We undertook this study to provide detailed information about the change of Q angle values with age and activity. METHODS: The study was conducted on 474 active (AG) (soccer players) and 765 sedentary (SG) boys (N=1239) from the age of 9-19, and the sedentary group also served as control to their age matched active counterparts. The statistical methods used were the student's t-test and the 3 way analysis of variance (ANOVA). The study was carried out in the laboratories of the Anatomy Departments and School of Physical Education and Sports, Istanbul and Hacettepe Universities between 2001 and 2003. RESULTS: The right and left Q angle values within both groups were statistically insignificant. The comparison of the groups showed a very high level of significant difference between the groups for both knees (AG right Q angle = 14.54 +/- 4.76, SG right Q angle = 17.98 +/- 3.24; AG left Q angle = 14.41 +/- 4.61, SG left Q angle = 18.12 +/- 3.55). The 3 way ANOVA showed that the age and physical activity had equally highly significant effects on Q angle values with a greater change in the active group's values. CONCLUSION: We conclude that 1) children and adolescents have greater Q angle values than adults, 2) a change in quadriceps strength and tone, caused by both growth and activity, results in a decrease of the Q angle and 3) activity, particularly playing soccer in our study, has a remarkable effect on the Q angle.

The efficiency of electromagnetic field treatment in Complex Regional Pain Syndrome Type I.

INTRODUCTION: Complex Regional Pain Syndrome Type I is a pathological condition that occurs without evident nerve injury and follows a course characterized by severe pain. PURPOSE: The aim of this study is to assess whether or not electromagnetic field treatment administered with calcitonin and exercise has positive effects on clinical improvement, scintigraphic assessment and bone markers compared to calcitonin and exercise administration. METHOD: In this randomized double-blind, placebo-controlled study, 40 patients with Complex Regional Pain Syndrome Type I, that developed after a Colles fracture were included in the assessments and were administered calcitonin and exercise treatment for 6 weeks. In addition to this treatment, half the patients received electromagnetic field treatment, and the other half received placebo treatment. The patients were evaluated at the beginning and end of treatment with clinical parameters, scintigraphic assessment and biochemical markers. RESULTS: Although we found some significant improvements in our evaluation criteria, we could not find a significant statistical difference between groups. CONCLUSIONS: The absence of a significant difference between the two groups in the assessment parameters has been interpreted as evidence that electromagnetic field treatment does not provide additional benefit to calcitonin and exercise treatment.

Electrical stimulation of denervated muscles.

PURPOSE: In this report, the 3-year rehabilitation of a 43-year-old male patient, who have pelvic 'open book' fracture, urinary bladder and urethral injury, lumbosacral plexus avulsion trauma and right lower extremity monoparesis is explained. METHOD: Rehabilitation of these injuries is absolutely essential to ensure optimal functional recovery. But the value of electrical stimulation for denervated muscle is not proven and its application to gain what may only be a small benefit is often not justified. CONCLUSIONS: With this case I emphasize that electrical stimulation and appropriate exercise programme in denervated protected muscle fibers activity for 3 years and rehabilitation should be continued.

[Conservative treatment of subacromial impingement syndrome]. / Subakromiyal sikisma sendromunda konservatif tedavi.

Impingement syndrome affects a wide range of active population with various pathologies and presentations. Symptoms include pain, weakness, and loss of motion. Causes of impingement include acromioclavicular joint arthritis, calcified coracoacromial ligament, structural abnormalities of the acromion, and weakness of the rotator cuff muscles. Conservative treatment (rest, ice packs, non-steroidal anti-inflammatory drugs and physical therapy) is usually sufficient. This paper evaluated some conservative treatment programmes.