Awareness and attitudes of oncology physicians recommending exercise to patients with cancer.

Objectives: The aim of our study was to evaluate oncology physicians' attitudes and awareness toward recommending exercise to their patients with cancer. Patients and methods: A total of 86 oncology physicians (52 males, 34 females; mean age: 46.7±10.9 years; range, 26 to 60 years) were included in the study between June 2019 and September 2019. A questionnaire was prepared to evaluate the physicians' perspectives about exercise and it consisted of five main sections including the physician's exercise habits, physicians' attitudes toward recommending exercise, the effects of exercise on cancer-related symptoms and cancer treatments, whether there was an exercise unit in the hospital, and whether the physician was referring the patients and on which subjects the physicians were willing to receive training. Results: A total of 87.2% of the physicians recommended exercise to their patients. There were three reasons for physicians who did not recommend exercise: "I don't have enough training to recommend exercise; I don't know which type of exercise to recommend; and I don't know what I should pay attention while recommending exercise." A total of 83.7% physicians considered that exercise reduced the symptoms associated with cancer. A total of 73.3%, 64%, and 80.2% physicians believed that exercise increased the effectiveness of chemotherapy, radiotherapy, and immunotherapy, respectively. About 94.2% of the physicians were willing to be trained on the effects of exercise in cancer. Conclusion: Oncology physicians believe that exercise has positive effects on cancer; however, they still need training on this subject.

Foot and ankle deformities in stroke: relationship with ambulation, balance, and daily living activities: a cross-sectional study.

BACKGROUND: Ankle-foot deformities play a critical role in functional capacity and therefore activities of daily living in stroke patients. AIM: This is the first study to evaluate all foot deformities in stroke patients together. The primary aim of this study is to determine the frequency of ankle-foot deformities in stroke patients. The secondary aim is to investigate the relationships between ankle-foot deformities and ambulation, postural control, balance, spasticity, and activities of daily living. MATERIAL AND METHODS: The Functional Ambulation Classification was used to assess ambulation status, Postural Assessment Scale for Stroke Patients was used to assess postural control and balance. Lower extremity spasticity was evaluated with Modified Ashworth Scale. Activities of daily living were evaluated with Barthel Index. RESULTS: Ankle-foot deformity was detected in 77 (42%) of 184 cases. The incidence of pes equinovarus was 48%, pes equinus was seen in 22%, claw toe in 19.5%, and pes varus in 10.4%. Pes equinovarus and claw toe were seen together in 8 cases. In the group with ankle-foot deformity, the disease duration was longer and the rate of spasticity in the lower extremity was statistically higher (p = 0.29, p = 0.023). There was no difference in Functional Ambulation Classification, Barthel Index, and Postural Assessment Scale for Stroke Patients scores between patients with or without ankle-foot deformity (p = 0.811, 0.321, 0.385). CONCLUSION: It is important to detect ankle-foot deformities in stroke patients. Ankle-foot deformities are associated with spasticity in patients with stroke and are an important factor to be considered when determining the rehabilitation program.

Idiopathic carpal tunnel syndrome and de Quervain's tenosynovitis: is there an association?

AIM: In this study, we aimed to investigate frequency of de Quervain's tenosynovitis (DQT) in patient with idiopathic carpal tunnel syndrome (ICTS). MATERIAL AND METHODS: We evaluated 356 hands of 310 patients who applied with the pre-diagnosis of ICTS. Patients who have pain over the radial styloid, pain on movement, tenderness over the first dorsal extensor compartment and also positive Finkelstein's test were accepted clinically DQT. Presence of DQT was confirmed by ultrasonography. Motor and sensory conductions of median and ulnar nerves were studied in every hand with the pre-diagnosis of ICTS. RESULTS: We determined ICTS in 302 (85%) hands. De Quarvain's tenosynovitis ratio was found to be 9.9% in hands with ICTS (n:302). In patients with ICTS and DQT in the same hand, the male-to-female ratio is 1/3. There were 29 cases (22 female, 7 male) with ICTS and DQT. Of the 30 hands with ICTS and DQT together; 18 had mild, nine had moderate, and 3 had severe ICTS. CONCLUSION: This is the first study that evaluates the DQT and ICTS together. We found that patients with ICTS have a prevalence higher than normal population to have DQT. We suppose that considering DQT in patients with the pre-diagnosis of ICTS during clinical evaluation has a positive impact on clinical follow-up and treatment of these patients.

Is it mastalgia or myofascial pain? A clinical confusion.

OBJECTIVES: This study aims to investigate the frequency of myofascial pain syndrome (MPS) and its characteristics in mastalgia patients. PATIENTS AND METHODS: The localization of pain, age, education, menopausal status, hormone replacement and employment status, and existence of comorbid diseases were reviewed on consecutive 131 female mastalgia patients (mean age 43.3±9.4 years; range, 18 to 75 years) in this prospective study conducted between June and December 2019. A total breast pain index (IBP) was obtained and mastalgia was classified according to these scores as mild, moderate, and severe. Patients were divided into four diagnostic groups of MPS, cyclic mastalgia, fibrocystic breast disease, and mastitis. RESULTS: The total IBP was significantly higher in MPS group (129.2±49.5) than in cyclic mastalgia group (98.3±11.9) (p<0.05). However, it was significantly higher in mastitis group (230.7±17.6) compared to MPS group (p<0.05). The fibrocystic disease group was similar to MPS group in terms of total IBP (p>0.05). Considering the localization of pain according to the quadrants where the pain was felt, 57.1% of the patients who felt pain in the upper quadrants were from MPS group (p=0.001) and 45.3% of the patients who felt pain in the lower quadrants were from cyclic mastalgia group (p=0.001). Myofascial pain was observed particularly in upper quadrants and almost all was unilateral; however, cyclic mastalgia was observed bilaterally in the majority, particularly in lower quadrants. CONCLUSION: Myofascial pain syndrome should be kept in mind as an extramammary disorder in the differential diagnosis of particularly unilateral upper quadrant mastalgia. It may be for the benefit of patients complaining of mastalgia with no primary breast disorder to be consulted with a physiatrist.

Impact of Acupuncture on Chronic Insomnia: A Report of Two Cases with Polysomnographic Evaluation.

OBJECTIVE: This report aimed to present the acupuncture treatment response of two patients who were evaluated with polysomnography. CLINICAL FEATURES: Acupuncture treatment was planned for two patients who refused medical treatment with chronic insomnia. Polysomnographic evaluation was performed at baseline and 1 month after acupuncture treatment. CONCLUSION: Remarkable improvement was determined in polysomnographic parameters of both cases. After acupuncture treatment, improvements in subjective symptoms such as unrefreshing sleep, morning headache, reduced motivation and daytime performance, tiredness, sleep disturbances, fatigue, and mood worsening in the morning were also observed. Clinical studies with more cases with polysomnographic evaluation are necessary to investigate the effectiveness of acupuncture in the treatment of insomnia.

Predictive Factors for Inpatient Falls among Children with Cerebral Palsy.

OBJECTIVE: Inpatient falls are of significant concern. The aim of this prospective study was to determine the predictors of inpatient falls among children with cerebral palsy in a rehabilitation hospital. DESIGN AND METHODS: A total of 93 patients with cerebral palsy were assessed based on history, physical findings, the Selective Motor Control Test, the Gross Motor Functional Classification System, the Berg Balance Scale and the Manual Ability Classification System. Previous history of falls/frequent falls, and any falls which occurred during hospitalization, were recorded. RESULTS: Of all 93 patients, 25 (27%) fell and 68 (73%) did not fall. The mean age of the fallers (6.3±2.0 years) was lower than that of the non-fallers (8.1±3.9 years). Behavioral problems according to the mother's statement (OR 26.454), not being able to maintain a long sitting position (OR 10.807), ability to balance on knees without support (OR 9.810), a history of frequent falls (OR 4.893) and a negative Thomas test (OR 4.192 fold) were found to increase the risk of inpatient falls. CONCLUSIONS: In these children with cerebral palsy, behavioral problems according to the mother's statement, a history of frequent falls, not being able to maintain a long sitting position, a negative Thomas test, and able to balance on knees without support were associated with the risk of inpatient falls. Children with cerebral palsy may experience inpatient falls. Further studies are required in order to develop prevention programs. PRACTICE IMPLICATIONS: For patients diagnosed with cerebral palsy, these results may help identify possible inpatient fallers on hospital admission.

Acupuncture for neuropathic pain due to bortezomib in a patient with multiple myeloma.

Multiple myeloma (MM) is characterised by an increase in plasma cells, particularly in the bone marrow but also in other organs and systems, and with the abnormal production of immunoglobulin. Bortezomib, a current treatment option, inhibits angiogenesis by proteasome inhibition and is known to be effective in the treatment of MM. Peripheral neuropathy (PN) is a common dose-related side effect of bortezomib in patients with MM. We describe a case of PN due to bortezomib treatment which responded dramatically to acupuncture treatment, enabling his bortezomib treatment to continue. The patient was a 74-year-old man with pain, numbness, tingling and weakness in his hands and feet after 22 days of bortezomib treatment given by the haematology clinic. His neuropathic pain score was 8/10. There were no autonomic symptoms. Electroneurophysiological testing confirmed sensorimotor PN. Acupuncture treatment was planned as his neuropathic pain continued. Acupuncture was administered bilaterally to ST36, SP6 and LI4 15 times (every other day in the first five sessions and then twice a week). The numbness, tingling and pain symptoms substantially decreased after the first two treatments. After the 15th session acupuncture treatment was continued once a month. At the end of the sixth month the neuropathic pain assessment score was 0/10. There was no side effect of acupuncture treatment. Acupuncture seems promising as a complementary medical treatment for neuropathic pain from bortezomib-induced PN. Clinical studies involving more cases and electrophysiological studies are necessary to investigate the effectiveness of acupuncture.