Analysis of corneal topographic and endothelial cell properties in newly diagnosed obstructive sleep apnea patients: A case-control study.

PURPOSE: To investigate the topographic features and endothelial cell changes in the corneas of patients with newly diagnosed obstructive sleep apnea (OSA). BACKGROUND: This cross-sectional case-control study included 98 patients with OSA and 90 healthy controls. OSA was diagnosed on the basis of a polysomnographic sleep examination. Patients with OSA were grouped according to their apnea-hypopnea index (AHI) scores. Corneal topographic measurements were obtained using the Scheimpflug-Placido disk topographer, and keratometry values, anterior chamber parameters, thinnest corneal thickness, symmetry index (SI), keratoconus vertex (KV), and the Baiocchi-Calossi-Versaci index, including keratoconus (KC) screening indexes, were recorded. The corneal endothelium was visualizedby specular microscopy, and the endothelial cell density, coefficient of variability (CV), and percentage of hexagonal cells (HEX) were recorded. RESULTS: In this study, 32 patients had mild, 34 patients had moderate, and 32 patients had severe OSA. The mean back KV (KVb) and back SI values were significantly higher in the OSA group than in the control group (P <0.001, P = 0.035, respectively). As body mass index (BMI) increased, KVb also increased significantly (r = 0.281; P = 0.009). The mean CV and HEX values differed significantly between the OSA and control groups (P = 0.012 and P = 0.002, respectively). In addition, a significant correlation was found between AHI and KVb and CV values (r = 0.315; P <0.001 and r = 0.231; P = 0.011, respectively). CONCLUSIONS: This study revealed abnormal changes in the corneal endothelial morphology and topographic KC screening indexes in relation to OSA severity in patients and controls. Further research is required to determine the effect of BMI on corneal topographic findings in patients with OSA.

Retinal microvascular changes in patients with coronary artery disease and apnea.

BACKGROUND: Optical coherence tomography angiography (OCT-A) allowed visualization of capillary level of retina; however, the relationship between coronary vascular status and retinal microvascular changes in patients with apnea is not known well. Our aim was to assess the retinal OCT-A parameters in patients with ischemia and angiographically proven microvascular disease and compare them with obstructive coronary disease in patients with apnea. METHODS: Our observational study included 185 eyes of 185 patients, 123 eyes of patients with apnea (72 eyes from mild OSAS, 51 eyes from moderate to severe OSAS) and 62 eyes from healthy controls. Radial scans of the macula and OCT-A scans of the central macula (superficial (SCP) and deep (DCP) capillary plexuses) were performed on all participants. All participants had documented sleep apnea disorder within 2 years prior to coronary angiography. Patients were grouped by severity of apnea and coronary atherosclerosis (50 % stenosis cut-off value for obstructive coronary artery disease). Patients presented with myocardial ischemia and without coronary artery occlusion (<50 % diameter reduction or FFR > 0.80) constitute the microvascular coronary artery (INOCA) group. RESULTS: Compared to healthy controls, patients with apnea showed deterioration in vascular density in all regions of the retina, regardless of obstructive or microvascular coronary artery disease on the ischemia background. This study has provided important observations of a high prevalence of INOCA in patients with OSAS and the presence of OSAS was a significant independent predictor of functional coronary artery disease. The relative decreases in vascular densities were more pronounced in the DCP layer according to SCP layer of macula. Only FAZ area values were significantly different according to the severity of OSAS (0.27 (0.11-0.62) and 0.23 (0.07-0.50) (p = 0.012)). CONCLUSIONS: In patients with apnea, OCT-A can be used as a noninvasive tool to define coronary artery involvement, with similar retinal microvascular changes both in obstructive and microvascular coronary artery group. In patients with OSAS, we observed a high prevalence of microvascular coronary disease, supporting pathophysiological role of OSAS in ischemia of this group of patients.

Frequency of overactive bladder (OAB) and the factors affecting it in patients with obstructive sleep apnea syndrome (OSAS).

PURPOSE: To investigate the prevalence of overactive bladder (OAB) in patients with obstructive sleep apnea syndrome (OSAS) and the factors affecting it. MATERIALS AND METHODS: A total of 255 patients were included in this prospectively designed study. Among all patients, 166 were male, 89 were female; 213 patients were married and 42 were single. All patients underwent polysomnography. All patients completed the OAB-V8 form. OSAS was diagnosed via polysomnography. OAB was diagnosed via OABV8. The participants were evaluated as patients with and without OAB and those with and without OSAS. SPSS for Windows version 18.0 software was used for the statistical analysis and the level of significance was set at α = 0.05. RESULTS: The prevalence of OAB was high among the OSAS patients (66.3%, n = 136). Age, body mass index, waist circumference, marital status, oxygen desaturation index (ODI4) ⩾4%, apneahypopnea index (AHI), the number and duration of decreases in O2 saturation below 90%, wake after sleep onset (WASO) duration, and groups, and OSAS severity were different in the OAB group (p < 0.05). Duration and number of O2 saturation <90%, and ODI4 are higher in the OSAS group and OAB group (p < 0.05). In multivariate logistic regression analysis, AHI, WASO, age, and marital status were the factors influencing OAB. CONCLUSION: OAB is seen at a high rate in OSAS patients. Hypoxia is the main basis for both diseases and probably it is the common pathway. AHI, WASO, age, and marital status can provide valuable information to physicians for predicting OAB.

Evaluating the relationship of sleep quality and sleep duration with Framingham coronary heart disease risk score.

Sleep is an important modulator of cardiovascular function and is recognized to play an important role in the pathogenesis and progression of cardiovascular disease. However, results of the studies investigating the relationship between sleep complaints and cardiovascular outcomes are still controversial. This study aimed to investigate the associations of sleep duration and sleep quality with Framingham 10-year hard coronary heart disease (CHD) risk score in Turkish adults. We included a total of 362 participants (mean age: 48.5 ± 9.0 years, 50.6% males) and measured sleep quality and sleep duration using Pittsburgh Sleep Quality Index (PSQI). Framingham risk scoring system was utilized to calculate the 10-year hard CHD risk of participants. Binary logistic regression analysis was performed to determine the association between sleep quality, sleep duration, and CHD risk. Both short sleep duration (<6 hours) (OR = 3.858, 95% CI: 1.245-11.956) and long sleep duration (≥8 hours) (OR = 2.944, 95% CI: 1.087-7.967) were identified as the predictors of 10-year hard CHD risk. However, sleep quality was not associated with 10-year CHD risk even as a categorical or continuous variable (OR = 0.864, 95% CI: 0.418-1.787 and OR = 0.985, 95% CI: 0.868-1.117, respectively). Our findings highlighted previous studies demonstrating the U-shaped relationship, with both short and long sleep durations to be associated with a higher CHD risk. Evaluation of habitual sleeping patterns may provide additional information in clinical cardiovascular risk assessment. Future research should investigate whether interventions to optimize sleep duration may help to prevent coronary events in large population-based cohorts.

Evaluation of the efficacy of therapeutic ultrasound in the treatment of migraine.

Objectives: This study aims to evaluate the efficacy of therapeutic pulsed ultrasound (US) applied to the occipital nerve distribution area in chronic migraine patients. Patients and methods: This prospective, randomized, double-blind, placebo-controlled, study was conducted on 58 patients diagnosed with migraine at the University of Health Sciences Bursa Yüksek Ihtisas Training and Research Hospital, Department of Physical Medicine and Rehabilitation between January 2018 and October 2018. The patients were randomly divided into two groups as sham and pulsed US group. Pulsed US was applied in Group 1 (n=29), and sham US was used in Group 2 (n=29) for 5 min for a total of 10 sessions in each group. The evaluation was made at pre-treatment, post-treatment first month (week six) and third month (week 14) using the numeric rating scale, and the Migraine Disability Assessment Scale (MIDAS). The final analysis was conducted with 52 patients (7 males, 45 females; mean age: 38.3±7.9 years; range, 20 to 65 years) due to drop-outs, with 27 patients in Group 1 and 25 patients in Group 2. Results: A statistically significant improvement was found in all parameters at week six and week 14 compared to pre-treatment values in Group 1. A statistically significant worsening was detected in MIDAS 1, 4, 5, total questions, and a significant improvement was found in MIDAS A and B at week six compared to pre-treatment values in Group 2. A statistically significant worsening was found only in MIDAS total score at week 14 compared to pre-treatment values. In the comparison of the difference scores of the two groups, all parameters in Group 1 showed significant improvement at week six and week 14. Conclusion: The findings obtained in this study show that pulsed US applied to the occipital nerve distribution region in migraine patients can be effective on headache frequency, severity, and disability.

Evaluation of the corpus callosum shape in patients with obstructive sleep apnea.

BACKGROUND: The aim of this study was to examine whether or not there was a difference in corpus callosum shape between patients with mild to moderate and severe obstructive sleep apnea (OSA) compared with patients who have simple snoring. METHODS: The landmark coordinate data was obtained from the mid-sagittal magnetic resonance imaging (MRI) images of 70 patients who underwent polysomnography. For comparisons, mild and moderate OSA groups were combined and analyses were performed on three groups; simple snoring/control group, mild or moderate OSA group, and severe OSA group. RESULTS: The corpus callosum shape of controls was significantly different from that of the severe OSA group. The most prominent deformities were observed in the genu and rostral body of the corpus callosum for the patients with severe OSA. No significant difference was found between mild/moderate OSA group and simple snoring group in terms of global corpus callosum shape. CONCLUSION: The data demonstrated that severe OSA patients have structural changes in the corpus callosum and deformities may vary as the severity of disease changes.

Anxiety and depression levels in Covid-19 disease and their relation to hypertension.

Objectives: The study aimed to assess the relation of anxiety and depression levels with hypertension in COVID-19 outbreak. The analysis of the association of selected socio-demographic and clinical parameters on the presence and severity of psychological distress was also performed. Methods: The study involved 91 patients applying with a medical history supportive of COVID-19 infection. According to the hospitalization criteria and diagnostic result of SARS-CoV-2 nucleic acid test certainty of the disease, three groups were created. Patients with positive SARS-CoV-2 nucleic acid test results were consisted of 31 hospitalized subjects. To assess the applicant psychological state, a specially developed questionnaire was used, as the presence and severities of the symptoms were assessed using the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). Results: Statistically, a significantly higher average level of depression and a higher incidence of anxiety were demonstrated among applicants in the Covid-19 pandemic (% 24 and % 44). Also a higher level of anxiety was demonstrated in hospitalized patients compared with the outpatient group. Different from the presence of depression symptoms, the presence of anxiety symptoms was associated independently with hypertension in our study group OR 2.6 (95% CI, 0.99-6.78) P = .04). Conclusions: In the aftermath of COVID-19 outbreak both anxiety and depression are common psychological disorders. Also, different from the symptoms of depression, the symptoms of anxiety are associated independently with hypertension. The described socio-demographic parameters and clinical characteristics had no impact on the symptoms of depression and anxiety irrespective of hospitalized status in the investigated groups.

Early Maladaptive Schemas, Depression, Distress and Discomfort Tolerance in Migraine Headache

ABSTRACT Background: Depression and maladaptive schemas were found to worsen the pain experience in individuals with chronic pain. Objectives: The aim of the present study was to evaluate the relationship between depressive symptoms, early maladaptive schemas, distress and discomfort tolerance in female patients with migraine. Methods: Seventy eight female migraine patients(37 depressed and 41 non-depressed subjects according to BDI scores) and 55 healthy controls were evaluated with Numeric Pain Rating Scale(NPRS),Beck Depression Inventory(BDI),Young Schema Questionnaire-Short Form-3(YSQ-SF-3),Discomfort Intolerance Scale(DIS) and Distress Tolerance Scale(DTS). Results: Distress and discomfort tolerance were lower in both migraine groups than control subjects. EMSs were higher in depressed migraine patients than in non-depressed migraine group and non-clinical controls. A positive correlation between BDI and YSQ-SF-3 scores(p<0.001), a negative correlation between BDI and DIS(p<0.01), and also a negative correlation between BDI and DTS(p<0.001) were found among migraine patients. Hierarchical regression analysis revealed that 20% of the depressive symptoms were explained with DIS scores, while explanatoriness raised up to 46% by addition of YSQ-SF-3 scores to the model. Discussion: Cognitive interventions for modifying EMSs and improving distress and discomfort tolerance might be added to the treatment strategies in female migraine patients.

Epicardial Adipose Thickness and Neutrophil Lymphocyte Ratio in Acute Occlusive Cerebrovascular Diseases.

OBJECTIVES: We investigate the relationship between the severity of vascular disease and epicardial adipose tissue thickness(EAT-t) and the neutrophil/lymphocyte (NEU/LY) ratio in acute stroke patients. METHODS: Seventy-six patients and 38 healthy controls were included in the study. Strokes were divided into three groups: lacunar infarction, middle cerebral artery infarction (MCA), and other arterial infarcts. Patients were assessed using the GCS (Glasgow coma scale) and NIHSS (National Institutes of Health Stroke Scale) scales. In addition to laboratory measurements, EAT-t was evaluated in all patients by using echocardiography. RESULTS: The EAT-t value and NEU/LY ratio were higher in the patient group than in the control group. The MCA group was found to have a significantly higher NEU/LY ratio than the lacuna group (p = 0.017) as well as the other patient (p = 0.025) group. There was a positive correlation of NIHSS score with EAT-t (r = 0.291; p = 0.013), and NEU/LY ratio (r = 0.289; p = 0.014). CONCLUSION: The EAT-t and NEU/LY ratio were high in patients with acute ischemic stroke patients. The higher ratio of NEU/LY compared to other infarcts in the MCA group. These findings support the relationship between acute ischemic stroke severity and inflammation .

Can continuous positive airway pressure improve lower urinary tract symptoms and erectile dysfunction in male patients with severe obstructive sleep apnea syndrome?

PURPOSE: We aimed to investigate the effect of continuous positive airway pressure (CPAP) administered for the treatment of obstructive upper airway on lower urinary tract symptoms and erectile dysfunction in male patients. MATERIALS AND METHODS: A total of 626 male with suspected obstructive sleep apnea syndrome (OSAS) were evaluated prospectively. Nocturnal polysomnography tests were administered to the male. After application of the exclusion criteria, 54 patients with severe OSAS (Apnea-Hypopnea Index ≥30) were included in the study. International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF-15), and nocturia were assessed in all patients before and after CPAP therapy, and prostate volume, total prostate-specific antigen (tPSA), and uroflowmetric measurements were assessed in patients aged >40 years. RESULTS: The mean age of the 54 patients was 47.06±11.15 years. Post-treatment IIEF scores were better than pre-treatment scores (24.27±7.58 vs. 22.68±8.65, p=0.014). IPSS values, nocturia, and uroflowmetric outcomes significantly improved after CPAP therapy (p<0.05). On the other hand, mean values of body mass index, tPSA, prostate volume, and postvoid residual urine volume did not differ significantly after treatment. CONCLUSIONS: CPAP therapy improves lower urinary tract symptoms, nocturia, and erectile dysfunction in male with severe OSAS.

Associations Between Olfactory Impairment and Cognitive Functions in Patients with Parkinson Disease.

INTRODUCTION: Olfactory impairment and cognitive impairment are common non-motor symptoms in Parkinson's disease (PD). Olfactory impairment may be present even many years before the main symptoms of the disease develop. The associations between olfactory loss and cognition in PD are evaluated in this study. METHODS: 31 patients with PD and 31 healthy subjects were included in this study. The Unified Parkinson's Disease Rating Scale (UPDRS) and Hoehn and Yahr Scale (H&Y Scale) were administered to all subjects. Butanol threshold test and Sniffin'Sticks test were used to assess olfaction. The Mini Mental State Examination (MMSE) and Clock Drawing Test (CDT) and Stroop Color Word Test (SCWT) were used to assess cognition. RESULTS: The Sniffin'Sticks test scores were significantly lower in the Parkinson group in comparison to the control group (p<0.001). The rate of anosmia was 90% in the PD group while this rate was found to be 54.8% in control group (p=0.005). A significant correlation was found between butanol test scores and stoop 5 and 5 errors. Significant correlations were found between the Sniffin'Sticks scores and MMSE scores (p=0.047) and orientation (p=0.041) and language (p=0.003) functions of the MMSE test. Worse olfaction was associated with worse memory. CONCLUSIONS: In PD, olfactory impairment correlates with cognitive impairment and olfactory tests may be used to predict the likelihood of developing dementia in this patient population.

Statistical shape analysis of corpus callosum in restless leg syndrome.

OBJECTIVES: In this study we aimed to investigate corpus callosum shape differences between restless leg syndrome patients and healthy controls, and to determine whether disease severity and duration are indicators for corpus callosum deformation in RLS patients. METHODS: This study was conducted using the magnetic resonance imaging scans of 33 restless leg syndrome patients and 33 control subjects. Landmarks were marked on the digital images and callosal landmark coordinate data were used to assess shape difference by performing Generalized Procrustes analysis. The shape deformation from controls to the patients was evaluated performing the Thin Plate Spline approach. RESULTS: There was a statistically significant shape difference between the groups. Highest deformation was determined at the posterior midbody of the corpus callosum. Growth curve analyses showed that with the increase in disease duration and severity, the CC size decreased. DISCUSSION: The present study demonstrated callosal shape differences in restless leg syndrome using a landmark-based geometric morphometric approach, considering the topographic distribution of corpus callosum for the first time.

Is there a relationship between hematological parameters and duration of respiratory events in severe OSA.

Aim: The aim of this study was to compare hematological parameters with the mean obstructive apnea duration (MOAD), mean mixed apnea duration (MMAD), mean central apnea duration (MCAD), mean total apnea duration (MTAD) and mean hypopnea duration (MHD), and blood oxygenation, other polysomnographic sleep parameters in patients with severe OSA.Material and methods: A retrospective study included 120 patients with severe OSA. The correlations between the hematological parameters with MOAD, MMAD, MCAD, MTAD, MHD, and blood oxygenation, other polysomnographic sleep parameters were analyzed.Results: There was a positive correlation between hgb with MOAD, MMAD, MTAD MCAD, MHD; mean oxygen desaturation, and the number of desaturation (≥5%). Also, hgb associated negatively with N1 sleep, WASO (wake time after sleep onset) and positively with REM, N2 sleep, total sleep time, and sleep efficiency. RDW and MOAD, MTAD, MHD were negatively related. Also, RDW related positively with sleep latency, WASO, and N1 sleep; negatively with sleep efficiency and REM sleep. There was no relationship between duration of respiratory events with NLR, PRL, and MPV.Conclusions: Hematological parameters, especially hgb and RDW, can be used to assess the severity of the disease in severe OSA patients in addition to AHI.

Which is more important: the number or duration of respiratory events to determine the severity of obstructive sleep apnea?

Aim: Apnea-hypopnea index (AHI) take account only the number of apnea and hypopnea regardless of their duration and morphology. The aim of this study was to compare the mean obstructive apnea duration (MOAD), mean mixed apnea duration (MMAD), mean central apnea duration (MCAD), mean total apnea duration (MTAD) and mean hypopnea duration (MHD) with the demographic parameters, blood oxygenation and other polysomnographic sleep parameters in patients diagnosed with severe obstructive sleep apnea (OSA).Materials and methods: A retrospective study included 121 patients who had a diagnosis of severe OSA. The correlations between the MOAD, MMAD, MCAD, MTAD, MHD and patient demographic parameters, blood oxygenation and other polysomnographic sleep parameters were analyzed.Results: Severe OSA patients with longer MOAD and MTAD had shorter Stage N3. Longer MOAD, MMAD, MCAD, MTAD, MHD were related to lower mean oxygen saturation. Longer MOAD and MTAD were associated with higher oxygen desaturation index. MOAD, MMAD, MTAD were positively associated with a duration below oxygen saturation 85%.Conclusions: Respiratory events can have different characteristics even though the average number of events per hour would be similar. Novel parameters like MOAD, MMAD, MCAD, MTAD, MHD could enhance the evaluation and classification of OSA in addition to AHI.

Assessment of Neurodegeneration by Optical Coherence Tomography and Mini-Mental Test in Parkinson's Disease.

BACKGROUND: Parkinson's disease is a neurodegenerative disease. Cognitive disorders and retinal degeneration may occur during the early stages of the disease. Retinal degeneration and cognitive findings can be assessed easily with optical coherence tomography and mini-mental test, respectively. MATERIALS AND METHODS: Twenty-two patients who are being followed-up with Parkinson's disease and 22 healthy controls have been included in the study. The Unified Parkinson's Disease Rating Scale (UPDRS) and Hoehn-Yahr staging of the patients have been conducted at the time of admission. Retinal nerve fiber layer analysis and ganglion cell thickness (ganglion cell complexes [GCCs]) were evaluated through optical coherence tomography (OCT). And at the same time, we aimed to compare the stage of the disease, the UPDRS score and the duration of the disease with OCT and cognitive functions by mini-mental test. RESULTS: Mini-mental test total score value (P = 0.025) and language value (P = 0.021) were lower in the patient group compared to the control group. In patients, there is a reverse significant correlation between UPDRS-T and GCC-left-superior (r = -0.495; P = 0.026), GCC-left-inferior (r = -0.517; P = 0.019), and GCC-left-to (r = -0.508; P = 0.022). There is a significant parallel relation between recall and RFNL-right-mean (r = 0.626; P = 0.039). CONCLUSION: Our findings indicate that the neurodegeneration continues multisystemically and neurodegeneration increases simultaneously with the disease. OCT, which is a noninvasive method, can be used as an indicator of neurodegeneration in patients with Parkinson's disease.

Evaluation of retinal nerve fibre layer, ganglion cell layer and choroidal thickness with optical coherence tomography in migraine patients: a case-control study.

BACKGROUND: Evaluation of retinal nerve fibre layer (RNFL), ganglion cell layer (GCL) and choroidal thickness (CT) with optical coherence tomography (OCT) in chronic migraine patients, to compare with healthy controls. MATERIAL AND METHOD: Ninety-four eyes of 47 chronic migraine patients (Group 1) and 68 eyes of 34 healthy individuals (Group 2) were included in this prospective case-control study. The right and left eyes were separately evaluated. Mean peripapillary RNFL thicknesses, mean GCL measured from superior and inferior quadrants, and mean CT were measured at three different regions (central, 500 µm nasal and temporal region of the fovea). RESULTS: There was no statistically significant differences in RNFL between the two groups (p > 0.05), while CT values were significantly higher and GCL values were significantly lower in chronic migraine groups (p < 0.05). There were no statistically significant differences between migraine duration, frequency and length of attacks, presence of aura, relation to menstrual cycle, white matter lesions in cranial magnetic resonance imaging and RNFL, GCL and CT (p > 0.05). DISCUSSION: In this study, we observed chronic migraine disease does not have any effect on peripapillary RNFL thickness; however, increases in CT and decreases in GCL thickness were observed in migraine patients.

Obesity: a possible risk factor for restless legs syndrome.

AIM/BACKGROUND: Restless legs syndrome (RLS) is a frequent neurological and sleep disorder. Metabolic disorders are known to be related to sleep disorders. We prospectively evaluated whether obesity and its possible cofactors were related to the presence of RLS. MATERIALS AND METHODS: The study included 143 obese and 94 non-obese individuals. Obese patients had a BMI of 30 and over, while non-obese patients had a BMI lower than 30. Patients with arthritis and pregnancy were excluded but not those with diabetes mellitus. Participants who met diagnostic criteria recommended by the International RLS Study Group were diagnosed as having RLS. Depression, anxiety, daytime sleepiness, insomnia and sleep quality were evaluated in detail. RESULTS: The mean age of obese patients was 40.52 years and that of non-obese patients was 39.76 years. The mean body mass index was 36.77 in the obese group and 25.71 in the non-obese group. The occurrence of depression, anxiety, sleep quality, and insomnia scores were significantly higher in obese individuals. The evaluations of daytime sleepiness, sleep efficiency and sleep latency were not significantly different between the groups. DISCUSSION: Although the presence of RLS was correlated with obesity and vascular risk factors at a significant level, it was also shown that depression, anxiety and insomnia were significantly frequent in obese patients (although not daytime sleepiness). Further studies are needed.

Effectiveness of PELOID therapy in carpal tunnel syndrome: A randomized controlled single blind study.

Carpal tunnel syndrome(CTS) is the most common neuromuscular cause of upper extremity disability. We aimed to investigate the effectiveness of peloid therapy in patients with CTS. This randomized, controlled, single-blind study enrolled 70 patients between the ages of 30 to 65 who had a diagnosis of either mild, mild-to-moderate, or moderate CTS. The patients were randomized into two groups using random number table. In the first group, (Group 1)(n = 35), patients were given splint (every night for 6 weeks) + peloid treatment(five consecutive days a week for 2 weeks) and in the second group, (Group 2)(n = 28), patients received splint treatment(every night for 6 weeks) alone. The patients were assessed by using visual analog scale(VAS) for pain, electroneuromyography(ENMG), the Boston Carpal Tunnel Syndrome Questionnaire(BCTSQ), hand grip strength(HGS), finger grip strength(FGS), and Short Form-12(SF-12). The data were obtained before treatment(W0), immediately after treatment(W2), and one month after treatment(W6). Both in Group 1 and 2, there was a statistically significant improvement in all the evaluation parameters at W2 and W6 when compared to W0(p < 0.05). Comparison of the groups with each other revealed significantly better results for VAS, BCTSQ, mSNCV, SF-12 in Group 1 than in Group 2 at W2(p < 0.05). There was also a statistically significant difference in favor of Group 1 for VAS, BCTSQ, FGS and MCS at W6 when compared to W0 (p < 0.05). The results of our study demonstrated that in patients with CTS; peloid + splint treatment was more effective than splint treatment alone in pain, functionality and life quality both at after treatment(W2) and one month after treatment (W6). We may suggest peloid as a supplementary therapeutic agent in CTS.

Attitudes of neurology specialists toward older adults.

OBJECTIVE: Attitude of healthcare providers toward older people is very important in the aging world. Neurologists contact older adults very frequently. We aimed to investigate the attitudes of neurologists toward older adults. MEASUREMENTS: We recorded participants age; sex; duration of clinical practice in neurology; existence of older adult relatives; and history of geriatrics education, nursing home visits, older adult patient density in their clinical practice, and participation in voluntary public activities. UCLA Geriatrics Attitude Scale was used to evaluate participants' attitudes. RESULTS: A total of 100 neurologists participated in this study. Seventy-seven percent had positive, 3 % had neutral, and 20 % had negative attitudes. Twenty-seven percent of the participants had history of geriatrics education, and these participants tended to have a higher rate of positive attitudes. Neurologists with positive attitudes tended to be older than those with negative attitudes. Participants with history of living with older adult relatives had lower rates of positive attitudes. The most common diagnoses of the patients the participants encountered were stroke and dementia. Independent factors associated with positive attitudes were history of geriatrics education and older age. History of living with older relatives tended to have a negative effect. Most of the negative items of the attitude scale were associated with the natural course and behavior of the common diseases in neurology practice. CONCLUSIONS: Generalization of geriatrics education may translate into a better understanding and improved care for older patients. Development of instruments and implementation of qualitative studies to assess attitudes of neurologists toward older adults are needed.