Evaluation of subclinical atherosclerosis by ultrasound radiofrequency data technology in patients with psoriatic arthritis.

OBJECTIVE: This study aimed to assess the presence of subclinical atherosclerosis in patients with psoriatic arthritis using ultrasound radiofrequency data technology. METHODS: In all, 29 psoriatic arthritis patients and 42 age- and sex-matched healthy controls were included in this cross-sectional study. Arterial stiffness and carotid intima-media thickness measurements were performed in bilateral common carotid arteries using ultrasound radiofrequency data technology in all participants. RESULTS: In psoriatic arthritis patients, the mean carotid intima-media thickness, α and ß stiffness indices, and pulsed wave velocity value were significantly higher than those in the control group (542.3 (81.3) vs. 487.9 (64.1), 9.3 (6.3) vs. 3.9 (0.1), 18.7 (17.7) vs. 8.04 (4.2), and 10.2 (3.8) vs. 6.4 (1.5), p<0.05). The mean distensibility coefficient and compliance coefficient values of the patient group were significantly lower than those of the control group (0.014 (0.01) vs. 0.03 (0.01) and 0.57 (0.33) vs. 1.02 (0.4), p<0.05). No significant correlation was found between carotid artery hemodynamic parameters and symptom duration, duration of diagnosis and treatment, disease activity index for psoriatic arthritis scores, erythrocyte sedimentation rate, and C-reactive protein levels (p>0.05). CONCLUSION: In the results of our study, evidence of subclinical atherosclerosis has been detected in psoriatic arthritis patients without clinically evident cardiovascular disease or traditional cardiovascular risk factors.

The Relationship Between Urinary Symptom Severity And Functional Status In Patients With Stroke.

BACKGROUND: Lower Urinary Tract Dysfunction (LUTD) is a condition that is common in stroke patients and affects their quality of life and psychological state. AIM: To determine the factors affecting LUTD severity in stroke patients and to evaluate its relationship with functional status. METHOD: 77 stroke patients were included in our study. Demographic and stroke characteristics of all patients were recorded. Functional Ambulation Scale (FAS), Functional Independence Measure (FIM), the Core Lower Urinary Tract Symptom Score (CLSS) Questionnaire, Beck Depression Scale were administered to the patient. 33 of 77 patients had urodynamic study and these patients constituted the subgroup of the study. Patients were grouped according to type of disorder, type of detrusor and detrusor sphincter dyssynergia (DSD) using urodynamic study findings. RESULT: The mean CLSS of men was significantly higher than women (P = 0.017). A significant positive correlation was found between age and CLSS (P = 0.035 r = 0.24) and negative correlation was found between total FIM and all sub-parameter scores and mean of CLSS (P = 0.001 r = -0.467). CONCLUSION: LUTD is common in stroke patients and the presence of urinary symptoms is associated with poor functional status. No significant relationship was observed between urodynamic data except maximum flow rate and CLSS.

Evaluation of subclinical atherosclerosis by ultrasound radiofrequency data technology in patients with psoriatic arthritis

SUMMARY OBJECTIVE: This study aimed to assess the presence of subclinical atherosclerosis in patients with psoriatic arthritis using ultrasound radiofrequency data technology. METHODS: In all, 29 psoriatic arthritis patients and 42 age- and sex-matched healthy controls were included in this cross-sectional study. Arterial stiffness and carotid intima-media thickness measurements were performed in bilateral common carotid arteries using ultrasound radiofrequency data technology in all participants. RESULTS: In psoriatic arthritis patients, the mean carotid intima-media thickness, α and β stiffness indices, and pulsed wave velocity value were significantly higher than those in the control group (542.3 (81.3) vs. 487.9 (64.1), 9.3 (6.3) vs. 3.9 (0.1), 18.7 (17.7) vs. 8.04 (4.2), and 10.2 (3.8) vs. 6.4 (1.5), p<0.05). The mean distensibility coefficient and compliance coefficient values of the patient group were significantly lower than those of the control group (0.014 (0.01) vs. 0.03 (0.01) and 0.57 (0.33) vs. 1.02 (0.4), p<0.05). No significant correlation was found between carotid artery hemodynamic parameters and symptom duration, duration of diagnosis and treatment, disease activity ındex for psoriatic arthritis scores, erythrocyte sedimentation rate, and C-reactive protein levels (p>0.05). CONCLUSION: In the results of our study, evidence of subclinical atherosclerosis has been detected in psoriatic arthritis patients without clinically evident cardiovascular disease or traditional cardiovascular risk factors.

Assessment of nocturnal polyuria in patients with spinal cord injury at three different mobilization phases: A multicenter cross-sectional study.

OBJECTIVE: To determine the prevalence of nocturnal polyuria (NP) in patients with spinal cord injury (SCI) during three different particular phases, and investigate the impact of injury level and injury type on the prevalence of NP. DESIGN: A cross-sectional study. SETTING: Neurogenic Bladder Study Group from six different rehabilitation centers across the country. PARTICIPANTS: 40 patients with SCI. OUTCOME MEASURES: Patients were divided into three groups according to mobilization phase; 1st group included patients confined to bed (n = 14), 2nd group included patients sitting on a wheelchair (n = 19) and 3rd group included patients standing with an assistive ambulation device (n = 7). NP was assessed by nocturnal polyuria index (NPi) and nocturnal urine production (NUP) indexes. RESULTS: No significant difference was found between the groups (P = 0.312 for NPi and P = 0.763 for NUP) in terms of the presence of NP according to their mobilization phase. The night and 24-hour urine volumes showed no significant difference between the groups (P = 0.907 and P = 0.395 respectively). The NPi and NUP values did not show a significant difference between male and female patients (P = 0.826, P = 0.364 respectively), patients with the injury level of ≥T6 and

When is needle examination of thenar muscle necessary in the evaluation of mild and moderate carpal tunnel syndrome?

OBJECTIVES: This study aims to evaluate the predictors of standard nerve conduction study (NCS) parameters in determining the presence of axonal loss by means of spontaneous activity in patients with mild and moderate carpal tunnel syndrome (CTS). PATIENTS AND METHODS: Between May 2015 and April 2018, a total of 118 patients (11 males, 107 females; mean age: 52.3±10.6 years; range, 27 to 79 years) who underwent electrophysiological studies and were diagnosed with CTS were included. Demographic data of the patients including age, sex, and symptom duration were recorded. Electrodiagnostic studies were performed in all patients. All the needle electromyography (EMG) findings were recorded, but only the presence or absence of spontaneous EMG activities was used as the indicator of axonal injury. RESULTS: In 37 (31.4%) of the patients, spontaneous activity was detected at the thenar muscle needle EMG. No spontaneous activity was observed in any of 43 (36.4%) patients with normal distal motor latency (DML). There were significant differences in DMLs, compound muscle action potential (CMAP) amplitudes, sensory nerve action potentials amplitudes, and sensory nerve conduction velocities between the groups with and without spontaneous activity (p<0.05). The multiple logistic regression analysis revealed that DML was a significant independent risk variable in determining presence of spontaneous activity. The most optimal cut-off value for median DML was calculated as 4.9 ms. If the median DML was >4.9 ms, the relative risk of finding spontaneous activity on thenar muscle needle EMG was 13.5 (95% CI: 3.6-51.2). CONCLUSION: Distal motor latency is the main parameter for predicting the presence of spontaneous activity in mild and moderate CTS patients with normal CMAP. Performing needle EMG of the thenar muscle in CTS patients with a DML of >4.9 ms may be beneficial to detect axonal degeneration in early stages.

A comparison of urodynamic findings between patients with complete and incomplete traumatic spinal cord injuries.

Objective: To compare urodynamic findings between patients with complete and incomplete traumatic spinal cord injuries (SCI) and to determine whether it is important to test with urodynamic study in patients with incomplete SCI. Design: Retrospective study Setting: Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey Participants: A total of 66 patients with 36 complete and 30 incomplete traumatic SCI were included in the study, from July 2012 to September 2014. Interventions: Urodynamic study Outcome Measures: Maximum cystometric capacity (MCC) , vesicle pressure at MCC, detrusor function (detrusor overactivity or not), bladder complience, bladder storage and emptying disorders, post-void residual volume (PVR) and bladder emptying method were recorded. It was also recorded whether the patients used anticholinergic drugs before urodynamic study. Results: In urodynamic findings MCC, vesicle pressure at MCC, PVR, there was no statistically significant difference between complete and incomplete traumatic SCI patients. Also there was no statistically significant difference in low-compliance of detrusor frequency and bladder storage and emptying disorder frequency. Clean intermittent catheterization (CIC) was the most commonly recommended method after urodynamic studies in both groups of patients with SCI. Conclusions: In urodynamic study findings, there was no statistical difference between complete and incomplete traumatic SCI patients. The present study demonstrate that even if patients with incomplete SCI appear to be functionally better than the patients with complete SCI, urodynamic studies should still be performed in patients with incomplete SCI to identify bladder characteristics and to identify appropriate treatment.

The course of post-stroke bladder problems and their relation with functional and mental status and quality of life: A six-month, prospective, multicenter study.

OBJECTIVES: The aim of this study was to evaluate the frequency and course of post-stroke lower urinary tract dysfunction (LUTD) from early term up to a period of six months and to investigate the relation of LUTD with functional and mental status and quality of life (QoL) in stroke patients. PATIENTS AND METHODS: This prospective study included a total of 70 stroke patients (44 males, 26 females; mean age 62.7±7.0 years; range, 46 to 79 years) from five different centers across Turkey between June 2015 and January 2017. The patients were questioned using the Danish Prostatic Symptom Score (DAN-PSS) to evaluate LUTD and evaluated using the Modified Barthel Index (MBI), Incontinence QoL Questionnaire (I-QOL), and Mini-Mental State Examination (MMSE) at one, three, and six months. RESULTS: At least one symptom of LUTD was observed in 64 (91.4%), 58 (82.9%), and 56 (80%) of the patients according to the DAN-PSS at one, three, and six months, respectively. A statistically significant improvement was found in the DAN-PSS, MBI, MMSE, I-QOL total scores, avoidance and psychosocial subgroup scores at six months compared to the first month scores (p<0.05). There was a significant negative correlation between the DAN-PSS symptom score at one month and the MBI, MMSE, and QoL scores at six months. The DAN-PSS bother and total scores were found to be significantly and negatively correlated only with the subscales of the QoL questionnaire. CONCLUSION: Based on our study results, LUTD was very common and the prevalence of LUTD findings decreased constantly during six-month follow-up, showing an association with a poor cognitive and functional status and QoL in stroke patients with LUTD.

Post-stroke lower urinary system dysfunction and its relation with functional and mental status: a multicenter cross-sectional study.

BACKGROUND: Review of the literature clearly reveals that little is known about the association between functional and mental status, and Lower Urinary Tract Dysfunction (LUTD) in patients with stroke. OBJECTIVE: The aim of this study was to assess functional and mental status in stroke patients and to identify possible associations with the prevalence, severity and bother of LUTD. MATERIAL AND METHODS: This study was designed as a cross-sectional study and included 260 stroke patients enrolled from six different hospitals in Turkey. The patients were questioned using the Danish Prostatic Symptom Score (DAN-PSS) Questionnaire to evaluate LUTD, and evaluated using the Modified Barthel Index (MBI), Incontinence Quality of Life Questionnaire (I-QoL), and the Mini Mental State Examination (MMSE). RESULTS: At least one LUTD finding was reported in 243 (93.5%) patients; the most commonly encountered complaint in these patients was nocturia (75.8%). The mean MBI, MMSE, and I-QoL scores were found to be significantly lower in LUTD (+) patients compared to LUTD (-) patients (p = 0.000, p = 0.005, and p < 0.01, respectively). Similarly all parameters (MBI, MMSE, and I-QoL scores) assessed were found to be significantly lower for patients with urinary incontinence than those without incontinence (p = 0.000, p = 0.000, and p < 0.01, respectively). CONCLUSION: LUTD is a common problem in patients with stroke. LUTD is associated with poorer cognitive and functional status and the quality of life in these patients. We, therefore, suggest that bladder dysfunction should not be overlooked during rehabilitation of stroke patients.

Ulnar neuropathy due to heterotopic ossification: A rare complication after stroke.

Heterotopic ossification (HO) is a rare complication (0.5 to 1.2%) after stroke. Although there are few reports on ulnar neuropathy (UN) due to HO at the elbow after traumatic brain injury, thermal burn or upper limb trauma, there has been no case reported after stroke. Herein, we present a 32-year-old male patient with UN due to HO after stroke.

Bilateral peroneal neuropathy after bariatric surgery: A case report.

The popularity of bariatric surgery (BS) began to increase due to the dramatic rise in severe obesity in the past decades. Postoperative follow-up after BS is important to avoid possible medical complications. Therefore, medical complications after BS should be well-known and defined. Herein, we present a case of bilateral peroneal neuropathy (PN) developed after successful BS. The patient lost 40 kg during 16 weeks of follow-up. The foot drop developed after 18 weeks after surgery on the left side and than 24 weeks after surgery on the right side. Peroneal neuropathy-associated weight loss is usually unilateral. Bilateral PN with weight loss is uncommon. The rate of weight loss is an important risk factor for PN. This case report highlights the importance of optimal dietary after BS to control the weight loss rate and nutrient deficiency.

Handgrip Strength in Fibromyalgia.

OBJECTIVES: This study aims to compare the handgrip strength values of fibromyalgia (FM) patients and healthy individuals and to demonstrate the relationship between clinical factors and FM disease severity. PATIENTS AND METHODS: Twenty-five female patients (mean age 34±9.2 years; range 20 to 50 years) with FM and 23 age- and body mass index-similar healthy females (mean age 35.3±9.2 years; range 26 to 46) were included. Demographic characteristics of the subjects were recorded. Tender point count was noted in the patient group. Also; total myalgia score and fibromyalgia impact questionnaire scores were calculated. Handgrip strength was measured with Jamar® dynamometer. Patients who had fibromyalgia impact questionnaire scores ≥70 out of 100 were considered to have severe FM, while those who had scores<70 were considered to have moderate FM. RESULTS: There were no significant differences between the patient and control groups in terms of age, height, weight, and body mass index. However, patients' handgrip strength values were lower than those of the control group (p=0.011). In the patient group, positive correlation was only present between handgrip strength and body mass index values (r= -0.510, p=0.037). There was no significant difference between moderate and severe FM patients in terms of handgrip strength values. CONCLUSION: Fibromyalgia patients had decreased handgrip strength when compared to healthy subjects. Handgrip strength values of moderate and severe FM patients were similar. FM severity was correlated with body mass index and severity of myalgia.

Outcomes of bowel program in spinal cord injury patients with neurogenic bowel dysfunction.

In this study, we aimed to determine gastrointestinal problems associated with neurogenic bowel dysfunction in spinal cord injury patients and to assess the efficacy of bowel program on gastrointestinal problems and the severity of neurogenic bowel dysfunction. Fifty-five spinal cord injury patients were included in this study. A bowel program according to the characteristics of neurogenic bowel dysfunction was performed for each patient. Before and after bowel program, gastrointestinal problems (constipation, difficult intestinal evacuation, incontinence, abdominal pain, abdominal distension, loss of appetite, hemorrhoids, rectal bleeding and gastrointestinal induced autonomic dysreflexia) and bowel evacuation methods (digital stimulation, oral medication, suppositories, abdominal massage, Valsalva maneuver and manual evacuation) were determined. Neurogenic bowel dysfunction score was used to assess the severity of neurogenic bowel dysfunction. At least one gastrointestinal problem was identified in 44 (80%) of the 55 patients before bowel program. Constipation (56%, 31/55) and incontinence (42%, 23/55) were the most common gastrointestinal problems. Digital rectal stimulation was the most common method for bowel evacuation, both before (76%, 42/55) and after (73%, 40/55) bowel program. Oral medication, enema and manual evacuation application rates were significantly decreased and constipation, difficult intestinal evacuation, abdominal distention, and abdominal pain rates were significantly reduced after bowel program. In addition, mean neurogenic bowel dysfunction score was decreased after bowel program. An effective bowel program decreases the severity of neurogenic bowel dysfunction and reduces associated gastrointestinal problems in patients with spinal cord injury.

The effectiveness of balneotherapy in chronic low back pain.

The aim of this study is to determine the effectiveness of balneotherapy plus physical therapy versus only physical therapy in patients with chronic low back pain. In this trial, 81 patients with low back pain were followed up in two groups. Patients in group I (n = 44) were treated with physical therapy alone. Patients in group II (n = 37) were treated with balneotherapy in addition to the same physical therapy protocol in group I. Patients in both groups were given a home-based standardized exercise program. The following parameters were measured: visual analog scale (0-10 cm), fingertip-to-floor distance (cm), Oswestry Disability Index, and Short Form 36 quality of life scale. First evaluations were done at the time of enrollment, and second evaluations were done after accomplishment of a 3-week treatment program. There were no significant differences between the two groups for the sociodemographic features. All of the measured parameters improved in both groups. However, improvements in pain, functionality, and quality of life scores were found to be superior in the balneotherapy plus physical therapy group. For the patients with chronic low back pain, balneotherapy plus physical therapy is more effective, compared to physical therapy alone.

Musculo-skeletal pain, quality of life and depression in mothers of children with cerebral palsy.

OBJECTIVE: To evaluate musculoskeletal pain (MSP) in mothers of children with cerebral palsy (CP), and to determine the effects of zone of pain on health-related quality of life (QoL) and symptoms of depression. PATIENTS AND METHODS: The study included a total of 81 children with CP, together with their mothers (group 1), and a total of 60 healthy children, together with their mothers (group 2). Presence of MSP, and the zone of pain in mothers were evaluated [lower back pain (LBP), pain in other zones, without pain]. Mothers' QoL was assessed with Short Form-36 (SF-36) scale, and presence of symptoms of depression was assessed with Beck Depression Inventory (BDI). Multivariate analysis of variance test analysis was performed to see the main effects of the factors mother having a child with CP (group 1, group 2) and zone of pain (LBP, other, no pain) on the BDI scores and SF-36 QoL sub parameters of mothers. Logistic regression analysis was performed to determine the parameters predicting the presence of LBP in mothers in group 1. RESULTS: MSP and LBP were found to be significantly higher in group 1. Main effect of the mother having a child with CP on BDI score and physical role (PR) and mental health (MH) parameters was found to be significant. Mean BDI scores of mothers in group 1 was found to be significantly higher as compared to the other group, and mean PR parameter and MH values were found to be significantly lower. Main effect of the zone of pain (arising from the group of mothers with LBP) was found to be significant on physical functioning, bodily pain, general health perception, MH parameters and BDI. Logistic regression analysis showed that MH and bodily pain parameters significantly predicted the presence of LBP. CONCLUSION: Deterioration of MH in mothers with cerebral palsied child may be causing them to experience more LBP. Experience of increased LBP causes deterioration of health-related QoL.