Does fear of activity predict exercise capacity in patients with coronary artery disease in both sexes? A cross-sectional multicenter study.

Objectives: This study aimed to identify whether fear of activity predicts exercise capacity in patients with coronary artery disease (CAD) and whether there is a difference between sexes regarding this relationship. Patients and methods: One hundred ninety-seven patients (145 males, 52 females; mean age: 56.3±10.8 years; range, 22 to 80 years) with a diagnosis of CAD or cardiac event in the previous one to 60 months were enrolled in this cross-sectional multicenter study between November 2015 and February 2017. Demographic and clinical features were recorded. Fear of activity was assessed by the fear of activity scale in patients with CAD (FactCAD). A 6-min walk test was used to assess exercise capacity. Results: Female participants were older, less educated, and less employed (p=0.045, p=0.048, and p<0.001, respectively) than males. Prevalence of myocardial infarction was higher in males. Comorbidities were higher in females. Multiple linear regression predicted 6-min walk distance (6MWD) based on FactCAD, sex, and education level with an r-squared of 0.321 (p<0.001). Fear of activity had an effect on walking distance in males (each additional score of FactCAD predicts a decrease of 1.3 m in 6MWD), together with disease duration, presence of chronic pulmonary disease, and low back pain, whereas fear of activity was not a predicting factor on walking distance in females. Age, education, and presence of angina predicted 6MWD in females. Conclusion: This study emphasizes that fear of activity is one of the predictors of 6MWD in males with CAD, and its assessment is recommended as a possible barrier to rehabilitation.

COVID-19, cardiac involvement and cardiac rehabilitation: Insights from a rehabilitation perspective - State of the Art.

Since the beginning of the pandemic, many novel coronavirus disease 2019 (COVID-19) patients have experienced multisystem involvement or become critically ill and treated in intensive care units, and even died. Among these systemic effects, cardiac involvement may have very important consequences for the patient's prognosis and later life. Patients with COVID-19 may develop cardiac complications such as heart failure, myocarditis, pericarditis, vasculitis, acute coronary syndrome, and cardiac arrhythmias or trigger an accompanying cardiac disease. The ratio of COVID-19 cardiac involvement ranges between 7 and 28% in hospitalized patients with worse outcomes, longer stay in the intensive care unit, and a higher risk of death. Furthermore, deconditioning due to immobility and muscle involvement can be seen in post-COVID-19 patients and significant physical, cognitive and psychosocial impairments may be observed in some cases. Considering that the definition of health is "a state of complete physical, mental and social well-being", individuals with heart involvement due to COVID-19 should be rehabilitated by evaluating all these aspects of the disease effect. In the light of the rehabilitation perspective and given the increasing number of patients with cardiac manifestations of COVID-19, in this review, we discuss the rehabilitation principles in this group of patients.

The mitral valve prolapse frequency in healthy females with generalized joint hypermobility: A case-control study.

OBJECTIVES: The aim of this study was to investigate the frequency of mitral valve prolapse between healthy females with generalized joint hypermobility and healthy controls. PATIENTS AND METHODS: This observational, cross-sectional, controlled study included female individuals with generalized joint hypermobility (n=39, mean age: 20.5±1.1 years; range, 19 to 23 years) and healthy controls (n=42, mean age: 20.6±1.2 years; range, 18 to 23 years) between July 2017 and November 2017. The generalized joint hypermobility consisted of women with a Beighton score of ≥4, while the control group consisted of women with a Beighton score of ≤3. Echocardiography was performed to all participants. Mitral valve prolapse was defined as having single or bileaflet prolapse of at least 2 mm beyond the long-axis annular plane with or without mitral leaflet thickening. RESULTS: No significant difference was found in the age, height, body weight, and body mass index between the groups (p>0.05). The median Beighton score was 5 in the generalized joint hypermobility group and 2 in the control group. No mitral valve prolapse was detected in those with generalized joint hypermobility, while non-classical mitral valve prolapse was observed in one participant in the control group, indicating no statistically significant difference between the two groups (p>0.05). CONCLUSION: Our study results suggest that the frequency of mitral valve prolapse is comparable between the women with generalized joint hypermobility and healthy controls. Based on these results, routine assessment of mitral valve prolapse is not recommended in this population.

Pulmonary rehabilitation principles in SARS-COV-2 infection (COVID-19): The revised guideline for the acute, subacute, and post-COVID-19 rehabilitation.

Coronavirus disease 2019 (COVID-19) is a contagious infection disease, which may cause respiratory, physical, psychological, and generalized systemic dysfunction. The severity of disease ranges from an asymptomatic infection or mild illness to mild or severe pneumonia with respiratory failure and/or death. COVID-19 dramatically affects the pulmonary system. This clinical practice guideline includes pulmonary rehabilitation (PR) recommendations for adult COVID-19 patients and has been developed in the light of the guidelines on the diagnosis and treatment of COVID-19 provided by the World Health Organization and Republic of Turkey, Ministry of Health, recently published scientific literature, and PR recommendations for COVID-19 regarding basic principles of PR. This national guideline provides suggestions regarding the PR methods during the clinical stages of COVID-19 and post-COVID-19 with its possible benefits, contraindications, and disadvantages.

Ehlers-Danlos syndrome-related genes and serum strontium, zinc, and lithium levels in generalized joint hypermobility: a case-control study.

Aim of the study: Generalized joint hypermobility (GJH) is a common feature of almost all Ehlers-Danlos syndrome (EDS) types; however, its genetic basis remains unclear. Therefore, it is crucial to distinguish the genetic basis of GJH from other connective tissue disorders, including the different subtypes of EDS. The aim of this study was to determine the blood EDS-related gene expressions and serum element levels in GJH and reveal their predictive characteristics and correlations with the Beighton score. Materials and Methods: A total of 39 women aged 18-23 years with GJH and 38 age- and sex-matched controls were included in the study. Inductively coupled plasma mass spectrometry was used to analyze the serum levels of zinc (Zn), strontium (Sr), and lithium (Li). The relative expression levels of the EDS-related genes were determined using quantitative real-time polymerase chain reaction (PCR). Results: Our results showed that women with GJH possessed significantly lower Li and higher Zn and Sr levels than the controls. In addition, the gene expressions of TNXB and SLC39A13 were significantly higher, whereas those of COL1A1, COL1A2, COL5A1, FKBP14, and DSE were lower in the GJH group. Pearson correlation analyses revealed a strong negative correlation between the Beighton score and B4GALT7, FKBP14, COL1A1, and Li. However, a significant positive correlation was noted between the Beighton score and SLC39A13, TNXB, Zn, Sr, and B3GALT6. Conclusion: Our findings provide valuable basal levels for conducting gene function analysis of joint hypermobility-related connective tissue disorders.

The effects of COVID-19 on Physical Medicine and Rehabilitation in Turkey in the first month of pandemic.

OBJECTIVES: The outbreak of novel coronavirus-2019 (COVID-19) has affected Turkey very seriously, as well as all around the world. Many urgent and radical measures were taken due to the high contagious risk and mortality rate of the outbreak. It is noteworthy that isolation recommendations and the provision of health services for pandemic have a negative impact on Physical Medicine and Rehabilitation (PMR) services. In this study, we aimed to evaluate the effects of COVID-19 on the PMR services and physiatrists immediately after the first month of pandemic in Turkey. PATIENTS AND METHODS: An online survey consisting of 45 items was sent to the members of the Turkish Society of Physical Medicine and Rehabilitation. The main goal of the survey was to evaluate the changes in the provided service of PMR and conditions of physiatrists one month after the first reported COVID-19 case in Turkey. RESULTS: A total of 606 PMR specialists and residents responded to the survey. The mean number of the patients visited the outpatient clinics was 148.2±128.5 per week before the pandemic, it significantly decreased to 23.4±33.1 per week after the first month of the reported first COVID-19 case. Similarly, the mean number of the patients of inpatient service significantly decreased from 21.7±39.3 per week to 2.5±10.0 per week after the first month of the pandemic. Most of the residents (69%) reported that their training was seriously affected due to pandemic. From the economic aspect, 69.2% of the participants who were working at private hospitals reported a decrease in their monthly salary, and 21% of them were sent to an unpaid vacation. A total of 21.9% of private-practice institutions paused their services. During the first month, 46.9% of the participants were assigned to the different services such as COVID-19 inpatient service, emergency or COVID-19 outpatient clinics. According to the Republic of Turkey, Ministry of Health guideline and algorithm, 15.7% of the physicians were in the category of healthcare workers with suspected COVID-19. CONCLUSION: The COVID-19 pandemic affected seriously both the services and the PMR physicians as early as the first month. This effect is expected to become worse, when the duration of pandemic prolongs. Proper arrangements and measures should be planned to ameliorate the negative effects of the pandemic on the patients and PMR physicians.

Risk factors, fractures, and management of pregnancy-associated osteoporosis: a retrospective study of 14 Turkish patients.

Pregnancy-associated osteoporosis (PAO) is a rare but painful disease. The current study aimed to investigate the demographic and clinical features, risk factors, treatment options, and outcomes of Turkish patients with PAO. In our retrospective, cross-sectional, and descriptive study the time to PAO diagnosis was 3.6 months. Pain and loss of height were detected in 78.6% and 28.6% of patients, respectively. As such, 60.6% of patients reported fractures at the thoracic area, 30.3% at the lumbar area, and 9.1% at the sacral area. While 14.3% of patients had optimal vitamin D status during pregnancy, 64.3% had vitamin D deficiency, and 21.4% had vitamin D insufficiency. Of the patients, 21.4% received anticoagulant therapy during their pregnancy. Dual X-ray absorptiometry scans revealed that osteoporosis was predominantly in the trabecular bone (L1-L4 Z-score -2.9, Femur Z score -2.19). Management options included supplements of calcium with vitamin D (93%), weaning the baby (79%), specific treatments for osteoporosis (64%), use of a supportive corset (50%), and exercise (21%), respectively. In addition, after delivery, 35.7% of patients were administered denosumab, 21.4% bisphosphonate, and 7.1% were given teriparatide. Data of the clinical features, treatments, and outcomes of PAO may contribute to early detection and management.

The Cut-off Values for the Diagnosis of Hamstring Shortness and Related Factors

Background: Hamstrings are one of the most frequently evaluated muscle groups for flexibility in the lower extremity. Passive and active knee extension angle values are used as an indirect indicator of hamstring flexibility. However, the lack of consensus on the cut-off values leads to the use of inconsistent angle values in determining the hamstring tightness. Aims: To establish the normative and cut-off values of the passive and active knee extension angles for healthy young adults and to determine the associated factors including the quadriceps strength. Study Design: A cross-sectional study. Methods: A total of 123 volunteer university students, aged 18-24 years, who met the inclusion criteria were included in this study. Passive and active knee extension assessments of the subjects were performed. Subsequently, on the next day, both knee extensor concentric muscle strength of the participants was measured in the isokinetic system. The knee extension angles and the knee extensor strength were recorded as the mean values of the right and the left sides. Results: Passive knee extension angles of 17.1°±9.1° and 9.8°±5.7° and active knee extension angles of 17.8°±9.1° and 13.4°±6° were described as normative values in men and women, respectively. The cut-off values for the diagnosis of hamstring shortness were as follows: passive knee extension angle >32.2° for males and >19.2° for females and active knee extension angle >33.0° for males and >23.4° for females. A significant positive correlation was observed between knee extension angles and isokinetic knee extensor muscle strength in all participants. The knee extension angle and hamstring flexibility were not affected by dominance. Conclusion: The knee extension angles of healthy young people seem to be lower than the results currently reported in the literature. There s a positive correlation between knee extension angles and isokinetic knee extensor muscle strength.

Effects of clinical reanalysis in dual energy X-ray absorptiometry reports.

OBJECTIVES: This study aims to assess poor positioning rates of patients during X-ray and the accuracy of the analysis. PATIENTS AND METHODS: In this study, we reanalyzed 323 dual energy X-ray absorptiometry (DXA) reports, by evaluating the scan images for proper patient positioning and scan analysis. We reviewed reports, according to a checklist prepared considering the proposals of Watts and The International Society for Clinical Densitometry official positions for 2013 (which were the same as in 2015). At least two remaining vertebrae were used to derive new bone mineral density and new T-scores. RESULTS: Positioning failures were found in 64.7% of the spine X-rays, 60.5% of the hip X-rays, and 83.9% of X-rays of both regions. A total of 112 (34.7%) spinal DXA images needed new T-score adjustments. T-scores and bone mineral density differed between the first reports and the clinician reanalysis (p<0.001). CONCLUSION: The error rate in DXA reports was higher than expected. Clinician analysis of DXA reports are important. To obtain a quality DXA report, all healthcare professionals should be trained and reminded about this topic.