Is the Thoracic and Back Muscle Mass Associated with Disease Severity in Patients with COVID-19?

OBJECTIVE: With this study, it was aimed to investigate whether the thoracic muscle mass of patients with coronavirus disease 2019 was related to disease severity and disease characteristics and to evaluate whether muscle mass measurement had a predictive effect on predicting disease severity. MATERIAL AND METHODS: Two hundred twenty-three subjects (patient group = 161 and control = 62) who presented to our coronavirus disease 2019 outpatient clinic between May 2020 and September 2020 were included in the study. The medication, oxygen, and intubation requirements of the patients and their disease duration and hospital stay were also recorded. At the T4 level, thoracic and back (pectoralis, intercostalis, paraspinals, serratus, and latissimus dorsi) muscles and at the T12 level erector spinae muscles were measured in terms of area (cm2 ). RESULTS: T4-level muscle cross-sectional area results were found to be negatively correlated with the presence of pneumonia and the requirement of oxygen and intubation. In addition, both T4- and T12-level muscle cross-sectional area results were factors associated with oxygen and intubation requirements. T4-level muscle cross-sectional area results were also associated with the presence of pneumonia. CONCLUSION: We predict that there may be a relationship between the decrease in the mass of the accessory respiratory muscles and the severity of the disease.

Evaluation of the physical and emotional effects of the COVID-19 pandemic on patients with fibromyalgia and chronic low back pain: A multicenter cross-sectional controlled study.

Objectives: This study aimed to investigate the physical and emotional effects of the coronavirus disease 2019 pandemic in patients with fibromyalgia syndrome (FMS) and chronic low back pain (CLBP) patients. Patients and methods: The cross-sectional controlled study was performed with 1,360 participants (332 males, 1,028 females; mean age: 42.3±12.5 years; range, 18 to 65 years) between September 2020 and February 2021. The participants were evaluated in three groups: the FMS group (n=465), the CLBP group (n=455), and the healthy control group (n=440). Physical activity, pain levels, and general health status before and during the pandemic were evaluated in all participants. Stress levels were analyzed with the perceived stress scale (PSS) in all groups, and disease activity was analyzed with the fibromyalgia impact questionnaire (FIQ) in patients with FMS. Results: Patients with FMS had worsened general health status and pain levels during the pandemic compared to the other groups (p<0.01). The FMS group showed significantly higher PSS scores than those in other groups (p<0.01). There was a weak-positive correlation between FIQ and PSS parameters in patients with FMS (p<0.05, r=0.385). Conclusion: The general health status, pain, and stress levels of the patients with FMS and CLBP tended to worsen during the pandemic. This high-stress level appeared to affect disease activity in patients with FMS.

Role of Intraoperative Nerve Monitoring in Postoperative Muscle and Nerve Function of Patients Undergoing Modified Radical Mastectomy.

This study aimed to postoperatively evaluate the effects of intraoperative neural monitoring (IONM) on muscles and nerves in patients who underwent modified radical mastectomy (MRM). In the 11 patients included in the study, nerves were determined and protected by nerve monitoring during the axillary dissection (IONM group). In another 11 patients, nerve monitoring was not performed; however, protection of the same nerves was attempted through careful nerve dissection (cautious nerve dissection [CND] group). The control group consisted of 22 healthy subjects. Muscle and nerve functions were blindly evaluated by an experienced physical therapy and rehabilitation specialist using electromyography (EMG) and ultrasonography (US) methods. The EMG values of the pectoralis major muscle were similar in the IONM and control groups (1.97 mV/1.98 mV, p = 0.97) but significantly lower in the CND group (1.57 mV, p < 0.05). Significant differences were found in the US values of the pectoralis major and minor muscles between the IONM and CND groups. No significant difference was found between the IONM and control groups in terms of EMG values of the serratus anterior muscle. This is the first prospective randomized study to objectively evaluate preservation of the nerve through nerve monitoring and its functional results. Monitoring of nerves during MRM is of great importance in terms of demonstrating the positive effects on muscle and nerve functions.

How Does Nutritional Status Affect Outcomes in Patients with Neurological Diseases?

BACKGROUND: To evaluate the nutritional status of patients with neurological diseases during the rehabilitation process and to investigate the relationships between the nutritional status and disease severity and clinical evaluation outcomes. METHODS: In this prospective trial, 109 patients with a disease duration of <6 months, hospitalized for neurological rehabilitation in Physical Medicine and Rehabilitation Clinic, Ankara, Turkey were enrolled from 2014-17. All patients were assessed with the Mini Mental State Examination (MMSE) test, European Quality of Life Scale (Euro-QoL), Hospital Anxiety and Depression Scale (HADS), Pittsburg Rehabilitation Participation Scale (PRPS), and Functional Ambulation Category (FAC). Nutritional status was analyzed by biochemical and anthropometric parameters. The patients received a conventional rehabilitation program and a nutritional support according to clinical and laboratory findings for 4 weeks. The outcome data were evaluated at baseline and at the end of 4-week treatment. RESULTS: Linear regressions analysis revealed that the significant independent predictors that associated positively with baseline insulin (P=0.010) and negatively with baseline cortisol (P=0.020) levels were Brunnstrom upper and hand stages. Additionally, the significant independent predictor that associated positively with baseline insulin (P=0.041) was Brunnstrom lower stage. CONCLUSION: Insulin and cortisol levels may be predictors in motor function recovery of stroke patients in rehabilitation process. Early detection and treatment of malnutrition both during hospitalization and follow-up might be important for the improvement of outcomes.

The effect of task-oriented electromyography-triggered electrical stimulation of the paretic wrist extensors on upper limb motor function early after stroke: a pilot randomized controlled trial.

The combined effect of task-oriented motor training and electromyography (EMG)-triggered electrical stimulation (ES) has been examined in chronic stroke, but there are no published reports in patients with early stroke. Therefore, the purpose of this study was to determine the short-term and long-term effects of task-oriented EMG-triggered ES on upper limb motor function in acute/subacute stroke. Twenty-seven patients with stroke within the first 3 months after stroke onset were randomly allocated to an experimental group and a control group. Twenty-three patients (12 patients in the experimental group and 11 patients in the control group) completed the study. The control group received a conventional physical therapy for 20 sessions, and the experimental group received task-oriented EMG-triggered ES therapy for the wrist/finger extensors in addition to conventional physical therapy for 5 sessions a week for 4 weeks. Primary outcome measures were the Action Research Arm Test, the Brunnstrom stages of the hand/upper extremity, and the motor Functional Independence Measure. All patients were evaluated before the treatment, after the treatment, and at 3 months. The parametric and nonparametric statistics at the 5% level of significance (α=0.05) was used for testing the differences between the two groups at each main end point. At the end of the treatment, the experimental group showed significantly greater improvements in Brunnstrom stages and ARAT grasp/grip/pinch scores, but not motor Functional Independence Measure scores, when compared with the control group. The differences between the 3-months and postintervention evaluations were not significant between the two groups suggesting retention of the postintervention gains. Our results indicate that task-oriented EMG-triggered ES training may result in improvements in the paretic upper limb function in patients with acute/subacute stroke that are superior to the conventional treatment.

The psychometric evaluation of the Turkish version of the Mann Assessment of Swallowing Ability in patients in the early period after stroke

Background/aim: The Mann Assessment of Swallowing Ability (MASA) is an efficient tool that allows physicians to determine the alertness, cooperation, and respiration of patients, which are important factors when assessing swallowing . This study aimed to translate the MASA into Turkish (T-MASA) and to assess its reliability and validity in patients during the early period after a stroke . Materials and methods: The scale was administered to 141 patients in the early period after a stroke. For reliability, both internal consistency (Cronbach's alpha and corrected item-to-total correlations) and interrater reliability were analyzed. The procedures were scored by two blinded independent expert observers. The validity was assessed using the convergent validity. The cut-off value of the T-MASA for dysphagia was accepted as 169 points. The correlation between the MASA and endoscopic evaluation was evaluated. Results: The T-MASA showed good internal consistency using Cronbach's alpha (0.899­0.901) and corrected item-to-total correlations. In addition, the intraclass correlation coefficient scores indicated excellent agreement. A significant moderate negative correlation was found between endoscopic evaluation and the T-MASA in terms of the presence of dysphagia (r: ­0.324, r: ­0.302, respectively, and both P = 0.001) Conclusion: Our results suggest that the Turkish version of the MASA is a valid and reliable instrument when determining dysphagia in patients in the early period after a stroke.

An unexpected side effect: Wartenberg syndrome related to the use of splint during carpal tunnel syndrome treatment.

Isolated superficial radial neuropathy is a sensorial mononeuropathy and a rare clinical condition. In case of trapping of the sensorial branch of the radial nerve, symptoms such as burning type pain at proximal forearm and hand dorsoradial, hypoesthesia, numbness and tingling at hand dorsum and thumb radial side are observed. Muscular weakness and trophic changes are not seen, and electrophysiological assessment revealed normal motor nerve conduction values. Therefore, hand motor functions are not affected. The etiology of the isolated superficial radial nerve neuropathy is often associated with repeated use of wrist watches, forearm fractures, use of handcuffs, repetitive activities. In this report, we present a 59-year-old female case of isolated superficial radial nerve neuropathy diagnosed by electrophysiological evaluation who was treated for two months with carpal tunnel syndrome with altered symptoms and increased numbness. This is the first case of superficial radial nerve neuropathy following the splint use in the literature.

Laminin mimetic peptide nanofibers regenerate acute muscle defect.

Skeletal muscle cells are terminally differentiated and require the activation of muscle progenitor (satellite) cells for their regeneration. There is a clinical need for faster and more efficient treatment methods for acute muscle injuries, and the stimulation of satellite cell proliferation is promising in this context. In this study, we designed and synthesized a laminin-mimetic bioactive peptide (LM/E-PA) system that is capable of accelerating satellite cell activation by emulating the structure and function of laminin, a major protein of the basal membrane of the skeletal muscle. The LM/E-PA nanofibers enhance myogenic differentiation in vitro and the clinical relevance of the laminin-mimetic bioactive scaffold system was demonstrated further by assessing its effect on the regeneration of acute muscle injury in a rat model. Laminin mimetic peptide nanofibers significantly promoted satellite cell activation in skeletal muscle and accelerated myofibrillar regeneration following acute muscle injury. In addition, the LM/E-PA scaffold treatment significantly reduced the time required for the structural and functional repair of skeletal muscle. This study represents one of the first examples of molecular- and tissue-level regeneration of skeletal muscle facilitated by bioactive peptide nanofibers following acute muscle injury. SIGNIFICANCE STATEMENT: Sports, heavy lifting and other strength-intensive tasks are ubiquitous in modern life and likely to cause acute skeletal muscle injury. Speeding up regeneration of skeletal muscle injuries would not only shorten the duration of recovery for the patient, but also support the general health and functionality of the repaired muscle tissue. In this work, we designed and synthesized a laminin-mimetic nanosystem to enhance muscle regeneration. We tested its activity in a rat tibialis anterior muscle by injecting the bioactive nanosystem. The evaluation of the regeneration and differentiation capacity of skeletal muscle suggested that the laminin-mimetic nanosystem enhances skeletal muscle regeneration and provides a suitable platform that is highly promising for the regeneration of acute muscle injuries. This work demonstrates for the first time that laminin-mimetic self-assembled peptide nanosystems facilitate myogenic differentiation in vivo without the need for additional treatment.

Sensory disturbance and polyneuropathy in rheumatoid arthritis patients with foot deformity.

INTRODUCTION: Our aim in this study was to present the results of sensory evaluation tests and electrophysiological evaluations in rheumatoid arthritis (RA) patients with foot deformity and to determine their relation with general health status and lower extremity functionality. MATERIALS AND METHODS: Fifty-one patients with RA diagnosis and foot deformity were included in the study. Demographic and disease characteristics of the patients were recorded, and a detailed neurological examination was performed. Superficial sensation, pain, heat, vibration, and two-point discrimination sensation were evaluated in each foot, and their sum was used to determine the sensory deficits index (SDI) of 0-10. The presence of polyneuropathy was evaluated with electrophysiological methods. The Health Assessment Questionnaire and mobility and walking subscales of the Arthritis Impact Measurement Scales-2 were used to assess general health status and lower extremity functionality, respectively. According to the sensory examination and electromyography results, patients were compared in terms of their general health status and lower extremity functional status. RESULTS: Sensory disturbance was detected in 39 patients (74%) during the examination; however, 27 patients (52.9%) had polyneuropathy determined electrophysiologically. In patients with sensory deficits, statistically significant deterioration was detected in general health and foot functionality, including mobility and walking, when compared to patients with a normal sensory evaluation. CONCLUSIONS: Even in the presence of normal electrophysiological tests, sensory dysfunction alone seems to be associated with severe disability in general health status and foot functionality when compared to patients with a normal sensory examination.