Analysis of the effects of hypothalamic-pituitary-adrenal axis activity in menstrual cycle on ankle proprioception, dynamic balance scores and visual-auditory reaction times in healthy young women.

OBJECTIVES: Menstrual cycle (MC) can affect not only the female reproductive system, but also functions such as neuromuscular performance. For this reason, the aim of this study is to investigate the effect of hypothalamic-pituitary-adrenal axis (HPA) activity in MC on proprioception, balance and reaction times. METHODS: For cortisol analysis, saliva samples were taken from the same women (n=43) in the four phases of MC. While State Trait Anxiety Inventory-I (STAI-I) was applied in each phase to support cortisol analysis, pain was measured with visual analogue scale (VAS). Proprioception, dynamic balance, visual and auditory reaction times (VRT-ART) measurements were made in the four phases of MC. RESULTS: Cortisol, STAI-I and VAS scores, angular deviations in proprioception measurements, dynamic balance scores, VRT and ART measurements were found to show statistically significant difference between MC phases (p<0.05). As a result of the post hoc test conducted to find out which MC phase the statistical difference resulted from, it was found that statistically significant difference was caused by the mensturation (M) phase (p<0.05). CONCLUSIONS: It was found that neuromuscular performance and postural control was negatively affected by HPA axis activity in M phase of MC and by pain, which is a significant menstrual symptom.

Comparison of high-intensity laser therapy and combination of transcutaneous nerve stimulation and ultrasound treatment in patients with chronic lumbar radiculopathy: A randomized single-blind study.

OBJECTIVE: To compare the effects of high-intensity laser therapy (HILT) and a combination of transcutaneous nerve stimulation (TENS) with ultrasound (US) therapy on pain and functionality in patients with chronic lumbar radiculopathy. METHODS: This prospective randomized comparative study was conducted in Department of physical medicine and rehabilitation, Turgut Ozal Medicine Center, Malatya, Turkey from April 2016 to September 2016. A total of 54 patients with chronic lumbar radiculopathy were enrolled in this study. The patients were randomly divided into two groups: Group 1 (n:27) received 10 sessions of a combination of hot pack, TENS, US and exercise, and Group 2 (n:27) received hot pack, HILT and exercise. The outcomes measured were low back with unilateral leg pain level measured by visual analog scale (VAS) and functionality measured with the Oswestry Disability Index (ODI) at the end of the therapy and four weeks later. p-value less than 0.05 considered statistically significant. RESULTS: In two groups, VAS (low back with unilateral leg pain) and ODI scores showed significant changes. At the end of the 2 weeks intervention, participants in Group-1 showed a significantly greater decrease in pain than participants in Group-2. Statistically significant differences in pain variation and functionality (VAS and ODI) were observed four weeks after treatment sessions for participants in the TENS+US therapy group compared with participants in the HILT group. CONCLUSION: HILT and TENS+US combined with exercise were effective treatment modalities in decreasing the VAS and ODI scores. TENS+US combined with exercises were more effective than HILT combined with exercise.

Affective temperament profile in ankylosing spondylitis patients using TEMPS-A.

[Purpose] This study aimed to compare the most common dominant affective temperaments in Ankylosing Spondylitis patients and investigate the relationship between the dominant affective temperaments and pain levels, disease activity, quality of life, current depression, and anxiety level in Ankylosing Spondylitis patients. [Subjects and Methods] Fifty-one patients diagnosed with axial spondiloartropathy and forty-two age- and gender-matched control subjects were included in this study. Disease duration, erythrocyte sedimentation rate, serum C-reactive protein, pain by the Visual Analog Scale, disease activity by the Bath Ankylosing Spondylitis Disease Activity Index, functional status by the Bath Ankylosing Spondylitis Functional Index; psychological status by the Beck Depression Inventory, Beck Anxiety Inventory and overall health assessment by the Ankylosing Spondylitis Quality of Life Scale were assessed in patients. The Turkish version of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto Questionnaire was used to determine the dominant affective temperament. [Results] There was no statistical difference in the distribution of temperament subtypes between patients with Ankylosing Spondylitis and the controls. Depressive, anxious, and cyclothymic temperament scores were higher in patients with high values on the Bath Ankylosing Spondylitis Functional Index and Visual Analog Scale. There was a correlation between anxious subtypes of affective temperament scores and the value of Ankylosing Spondylitis Quality of Life Scale. Correlation analysis also found depressive, cyclothymic, irritable, and anxious temperament and psychiatric symptoms to be significantly related. [Conclusion] Affective temperament may contribute to symptoms of depression and anxiety in patients with Ankylosing Spondylitis and may increase disease activity and may reduce their quality of life.

Outcome of the treatment of chronic isolated and combined posterolateral corner knee injuries with 2- to 6-year follow-up.

INTRODUCTION: Injuries of the posterolateral corner (PLC) of the knee are rare. They are difficult to diagnose and can cause severe disability. This study presents the 20- to 70-month clinical and radiological outcomes of the anatomical reconstruction technique of LaPrade et al. MATERIALS AND METHODS: Twenty-one patients with chronic PLC injuries underwent anatomical PLC reconstruction. The anatomical locations of the popliteus tendon, fibular collateral ligament, and popliteofibular ligament were reconstructed using a 2-graft technique. The patients were evaluated subjectively with the Tegner, Lysholm, and International Knee Documentation Committee (IKDC) subjective knee scores and objectively with the IKDC objective scores; additionally, varus stress radiographs were taken to evaluate knee stability. RESULTS: Significant (p < 0.05) improvements were observed in the postoperative Lysholm, IKDC-s, and Tegner scores compared with preoperatively. The IKDC objective subscores (lateral joint opening at 20° of knee extension, external rotation at 30° and 90°, and the reverse pivot-shift test) had improved significantly at the time of the final 40.9 ± 13.7-month follow-up. Lateral compartment opening on the varus stress radiographs had decreased significantly in the postoperative period. However, there was still a significant difference compared with the uninjured knee. There was no significant improvement in the IKDC-s, Lysholm, or Tegner scores between the nine patients with isolated PLC injuries and twelve with multi-ligament injuries. CONCLUSIONS: Significant improvement in the objective knee stability scores and clinical outcomes with anatomical reconstruction showed that this technique can be used to treat patients with chronic PLC injured knees. However, longer-term multicentre studies and studies with larger groups comparing multiple techniques are required to determine the best treatment method for PLC injuries.

Prevalence of atopic disorders in rheumatic diseases.

OBJECTIVES: The aim of this study was to assess the point prevalences of hay fever, asthma, and atopic dermatitis in OA, RA, and AS, and to compare with healthy controls. METHODS: A total of 935 patients and healthy controls were included. Demographic and clinical features were recorded, and a questionnaire assessing the existence of atopic disorders like asthma, hay fever, and atopic dermatitis in all groups was applied. "Either atopy" implied that an individual was either diagnosed with or had symptoms of one or more of these disorders, such as asthma, hay fever, or atopic dermatitis. RESULTS: When compared to the controls, only patients with AS had an increased risk for hay fever (OR 1.52, 95 % CI 1.00-2.41). Patients with RA had increased risks for hay fever, atopic dermatitis, and either atopy compared to the patients with OA (2.14, 95 % CI 1.18-3.89; 1.77, 95 % CI 1.00-3.18; and 3.45, 95 % CI 1.10-10.87, respectively). Steroid use had no effect on the prevalence of atopic disorders in patients with RA. CONCLUSIONS: Patients with OA, RA, and AS seem to have similar risks for asthma, atopic dermatitis, and either atopy to healthy controls. However, the prevalence of hay fever may increase in AS. Patients with RA have a higher risk of atopy than patients with OA.

Can Blood Biomarkers Be Used to Assess Oxidative Stress in COPD Patients After Pulmonary Rehabilitation.

Purpose: To determine the level of oxidative stress in the body due to pulmonary rehabilitation (PR) with thiols and disulfide and to investigate their relationship with indirect markers such as creatine kinase (CK), creatine kinase - MB (CK-MB), and lactate dehydrogenase (LDH), which show cell destruction. Patients and Methods: Patients with chronic obstructive pulmonary disease (COPD) are included in inpatient and outpatient care. They were evaluated before and after for PR, and an exercise program was prescribed. In addition, native thiol (NT), total thiol (TT), disulfide (DS), LDH, CK, and CK-MB values were tested. Results: The mean age of 21 patients was 63±7.31 years. Eleven of them were outpatients and 10 of them were inpatients. Most of the patients were male (M/F=20/1, 95.2/4.8%). There was a significant difference in pulmonary function tests (PFT), St. George Respiratory Questionnaire (SGRQ), and 1 repetition maximum (1RM) before and after the treatment (p<0.001). There was a correlation between PFT and 1RM upper extremity. While there was no significant difference between thiols and disulfide, according to GOLD scores, there was a significant difference in patients with level 3-MMRC. No correlation was found between LDH, CK, CK-MB, and thiols, DS. ΔCK was found to be associated with ΔDS, and ΔCK-MB with ΔNT, and ΔTT. Conclusion: PR contributes to the antioxidant process by improving respiration and reducing oxidative stress. The decrease in LDH, CK with PR, increase in CK-MB, and correlation of CK with thiols and DS gave a different interpretation. In this case, it should be considered that oxidative stress may also be increased in people with high CK values.

Neuropathic pain in patients with post-COVID-19.

OBJECTIVE: In this study, we aimed to determine the continuing pain during the post-COVID-19 period the frequency of neuropathic pain in these patients, and the factors affecting the frequency. METHODS: A total of 209 participants were included in the study who had COVID-19 disease (PCR-positive) aged 18-75 years. The demographic characteristics and COVID-19 severity data were recorded by questioning the patients. The musculoskeletal pain was also assessed using Visual Analog Scale (VAS) and the extended Nordic musculoskeletal system questionnaire (NMQ-E). In addition, the neuropathic components of pain were evaluated using the Leeds Assessment of neuropathic symptoms and Signs (LANSS) pain scale and the Pain-DETECT questionnaire (PDQ). RESULTS: The mean time elapsed since COVID-19 was 5.76±2.95 months (min, 1; max, 12). Six patients (2.9%) had neuropathic pain according to the LANSS score, and 12 patients (5.7%) according to the PDQ score. The NMQ-E indicated that the most pain was detected in the back (20.1%), low back (15.3%), and knee (11.5%) regions during the post-COVID-19 period. According to both neuropathic pain scales; low back pain (p=0.001/0.001) and knee pain (p=0.001/0.01) were more common in patients with PDQ/LANSS neuropathic pain. Logistic regression analysis showed that there were significant associations between neuropathic pain and acute COVID-19 VAS score. CONCLUSION: This study demonstrated that musculoskeletal pain was prominent mostly in the back, low back, and knee during the post-COVID-19 period. The incidence of neuropathic pain was 2.9%-5.7% depending on the evaluation parameters. Neuropathic pain is a finding that should be considered during the post-COVID-19 period.

A new diagnostic scoring for discrimination of tuberculous and bacterial meningitis on the basis of clinical and laboratory findings.

OBJECTIVES: The aim of this study was to develop a new diagnostic index (DI) on the basis of clinical and laboratory findings including serum C-reactive protein (CRP) for tuberculous meningitis (TM) and bacterial meningitis (BM). SUBJECTS AND METHODS: During a 7-year period, 96 adult patients with meningitis (30 with TM and 66 with BM) were studied retrospectively. Multivariate logistic regression analysis was performed to investigate the diagnostic value of clinical and laboratory parameters as independent predictors on discrimination of tuberculous from BM patients. RESULTS: Six features predictive for diagnosis including age, CSF leukocyte count, PML dominance, length of illness, serum CRP level and blood WBC count were used. The DI model developed from these features had very high sensitivity and specificity rates of 100.0 and 95.4%, respectively. The sensitivity and specificity rates were 97.4 and 100%, respectively, in microbiologically proven cases. CONCLUSION: Our results suggested that this new DI which consists of simple clinical and laboratory parameters had the power to discriminate adult patients with documented tuberculous and BM (excluding Brucella meningitis). It should, however, be tested in prospective studies.

Relationship between psychological status and disease activity and quality of life in ankylosing spondylitis.

Our aim in this study was to compare the depression and anxiety risk in patients with AS and healthy controls and also to determine the relationship between disease activity, quality of life and psychological well-being. Two hundred and forty-three patients with ankylosing spondylitis (AS) and 118 age-, sex- and education-matched healthy controls were enroled into the study. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Functional Index, and Metrology Index, Health Assessment Questionnaire for Spondyloarthropathies (HAQ-S), Hospital Anxiety and Depression Scale (HADS) including depression subscale (HADS-D) and anxiety subscale (HADS-A), Ankylosing Spondylitis Quality of Life (ASQoL) Scale, duration of morning stiffness, pain-visual analogue scale (VAS), patient and physician's global assessment of disease activity (100 mm VAS) were used to assess clinical and psychological status. Patients had similar HADS-D but higher HADS-A than healthy controls. Patients with high risk for depression and anxiety had higher scores in BASDAI, BASFI and also poorer scores in VAS pain, patient global assessment, physician global assessment, HAQ-S and ASQoL. There was a negative correlation of HADS-D and HADS-A scores with educational level of the patients. Higher scores in HADS-D and HADS-A indicated poorer functional outcome and quality of life. Multivariate logistic regression analysis revealed that the HADS-D (OR=6.84), HAQ-S (OR=1.76), VAS pain score (OR=1.03) and ESR (OR=1.02) were independent risk factors for higher anxiety scores whereas HADS-A (OR=1.36) and ASQoL (OR=1.24) were independent risk factors for higher depression scores. The psychological status had close interaction with disease activity and quality of life in patients with AS.

Evaluation of visual and auditory reaction time, pain, and hand grip strength performance before and after conventional physiotherapy in patients with herniated cervical intervertebral disc with radiculopathy.

Objective: Herniated cervical intervertebral disc (cervical disc herniation [CDH]) with radiculopathy is known to occur in seven or eight out of 100 people worldwide. This disease causes movement limitation, loss of strength, and pain of upper extremity. The aim of this study is the effect of conventional physiotherapy agents on predetermined parameters in patients with cervical radiculopathy and to compare the results with healthy controls. Methods: A total of 102 patients with CDH with radiculopathy and 98 healthy controls were included in the study. Visual reaction time (VRT) and auditory reaction time (ART) measurements were evaluated with reaction timer, while the pain was assessed with visual analog scale (VAS) and handgrip strength (HGS) assessed with hand dynamometer, respectively. Conventional physiotherapy (transcutaneous electrical nerve stimulation, hot pack application, and therapeutic ultrasound) agents were applied 5 days/week for 3 weeks as treatment protocol. Results: As a result, VAS, VRT, and ART scores were significantly decreased, and HGS scores increased significantly in both female and male patients post-treatment measures (p<0.05). There was no statistically significant difference between patient group and control group measurements in post-treatment evaluations (p>0.05). Conclusion: This study presents the conclusion to literature that conventional physiotherapy agents have the effect of decreasing pain and regaining motor function and also a therapeutic effect on VRT and ART in the treatment of patients with CDH with radiculopathy.

Postural stability in patients with ankylosing spondylitis.

PURPOSE: The aim of this study is to determine whether the postural changes in ankylosing spondylitis (AS) affected postural stability. METHOD: A total of 64 patients with a diagnosis of AS and 50 healthy volunteers were included in the study. The patients were divided into two groups according to a tragus-to-wall distance<15 cm (Group I, n=30) and >or=15 cm (Group II, n=34). The control group (Group III) consisted of 50 healthy volunteers. The postural stability was evaluated with the Biodex Stability System (BSS). The results of Antero-Posterior Stability Index (APSI), Medio-Lateral Stability Index (MLSI) and Overall Stability Index (OSI) were evaluated. RESULTS: There were statistically significant differences between the three groups for OSI, APSI and MLSI. MLSI results were significantly different among patient groups. When Group II and the control group were compared, there were significant differences for OSI, APSI, and MLSI. Comparing Group I with the control group revealed a more significant difference for OSI, APSI, and MLSI. CONCLUSIONS: We have found that postural stability decreases in patients with AS in both the early and the late stages of the disease, but especially in the latter ones. This result may be thought to be related with increased kyphosis which is seen during the course of the disease.

Impacts of combined osteopenia/osteoporosis and sarcopenia on balance and quality of life in older adults.

OBJECTIVE: Combined osteopenia/osteoporosis and sarcopenia is a major public health problem for old adults. In this study, we aimed to evaluate the impacts of combined osteopenia/osteoporosis with sarcopenia on balance and quality of life in patients older than 65 years. METHODS: In this sudy, 77 patients with sarcopenia, who were older than 65 years, were included. The diagnosis of sarcopenia was made according to the diagnostic criteria developed by The European Working Group on Sarcopenia in Older People (EWGSOP). Bone densitometry was performed to screen for osteoporosis or osteopenia. The balance was assessed with the anterior-posterior stability index (APSI), medial-lateral stability index (MLSI), and the general stability index (OSI), which were calculated using a Biodex Stability System device (BSS). The quality of life was assessed using SF-36. RESULTS: Patients with sarcopenia were included in this study. Of them, 40 had osteoporosis and 37 had osteopenia. The measures of balance and the OSI, APSI, and MLSI values were low in both groups of patients, but they were statistically significantly lower in the sarcopenia with osteoporosis group compared to the sarcopenia with osteopenia group (p=0.01; p=0.002; p=0.04, respectively). The quality of life was lower in all sub-categories of SF-36, excluding the mental health when sarcopenia was accompanied by osteoporosis compared to the joint occurrence of sarcopenia with osteopenia (p<0.05). CONCLUSION: Our study suggests that the joint occurrence of osteoporosis with sarcopenia is associated with a risk of balance loss, a decrease in quality of life, and a potentially increased fracture risk in older adults.

Median nerve ultrasound in carpal tunnel syndrome with normal electrodiagnostic tests.

INTRODUCTION: To evaluate the ultrasound findings of the median nerve in patients with clinical assigned carpal tunnel syndrome but normal nerve conduction studies. METHODS: This prospective, cross-sectional study involved 41 patients (51 hands) with clinically assigned CTS and normal nerve conduction studies and 20 healthy controls (30 hands). Ultrasonography was performed in all participants, and cross-sectional area (CSA), hypoechogenicity, and mobility of the median nerve were evaluated. All patients were assessed with Boston Carpal Tunnel Questionnaire (BCTQ). RESULTS: CSA of the median nerve in the wrist was significantly higher in the patient group when compared to the control group. Echogenicity and mobility were significantly decreased in the patient group. Ultrasound abnormalities were positively correlated with clinical features. A significant correlation was observed among sensory loss, provocative tests, body mass index, BCTQ, and high CSA. CONCLUSION: US can help the clinicians with the diagnosis of carpal tunnel syndrome in patients with clinical symptoms but negative nerve conduction study results.

Predictive effects of different clinical balance measures and the fear of falling on falls in postmenopausal women aged 50 years and over.

BACKGROUND: Falls among the elderly are associated with a high morbidity and mortality and can involve high-cost medical interventions. The risk of falls often remains undiagnosed until an episode occurs but if the risk is high, preventative measures could be introduced. OBJECTIVES: This 6-month prospective study investigated whether different postural clinical measures and fear of falling (FOF) itself can predict future falls in postmenopausal women aged > or =50 years. METHODS: 125 postmenopausal women were studied comparing the outcome of fallers vs. non-fallers within the 6-month follow-up study period. Clinical measures, history of falls and FOF data were determined at baseline and the number of falls and FOF were ascertained at the final visit or by telephone interview at 6 months. RESULTS: Of the clinical measures investigated, the Falls Efficacy Scale International (FES-I) >26 points (OR = 7.28, per additional point, 95% CI 2.25-23.61, p = 0.001) and Berg Balance Scale (BBS) < or =52 points (OR = 4.77, per additional point, 95% CI = 1.15-19.82, p = 0.031) performed best in prediction of the future falls. CONCLUSIONS: Postmenopausal women aged > or =50 years who had FES-I scores >26 points and BBS < or =52 points should be examined for risk factors of future falls and offered preventative measures.

Functional outcomes following ultrasound-guided botulinum toxin type A injections to reduce spastic equinovarus in adult post-stroke patients.

OBJECTIVE: The aim of this study is to identify the effect on spasticity and walking of US-guided botulinum toxin type A (BoNT-A) injections administered to improve equinovarus walking pattern commonly observed in patients after stroke. MATERIAL AND METHOD: Twenty-three patients with post-stroke spastic equinovarus deformity were recruited. The US-guided BoNT-A injections were administered into the spastic muscles (including gastrocnemius; GK, soleus; S and tibialis posterior; TP) using a specific approach, and all of the patients were enrolled in rehabilitation programmes after the injections. Modified Ashworth Scale (MAS), Brunnstrom stage of lower limb, Functional Ambulation Score (FAS), Preferred Gait Speed (PGS) and the six-minute walk test (6MWT) were assessed at the baseline, 4 and 12 weeks after the BoNT-A injection. RESULTS: Significant decreases in the MAS scores of the lower limb muscle (GK, S and TP) tone were measured 4 and 12 weeks after the BoNT-A injection when compared to the baseline scores (p < 0.05). In parallel with a reduction in spasticity there was an increase in 6MWT and PGS in the 4th and 12th weeks. Increases in motor improvement and functional ambulation score were ensured in the 12th week (p < 0.05). CONCLUSION: Spastic equinovarus deformity observed in patients after stroke creates significant limitations in the patient's functional walking speed and distance. As a result, when BoNT-A injections accompanied by ultrasound to improve equinovarus deformity considering the innervation zones of the muscles with a specific approach are administered directly into the muscle at the correct point, we can say it provides hopeful results from a functional point of view.

Evaluating the functional outcomes of ultrasound-guided botulinum toxin type A injections using the Euro-musculus approach for upper limb spasticity treatment in post-stroke patients: an observational study.

BACKGROUND: Ultrasound-guided botulinum toxin type A injection is an effective treatment for spasticity. Euro-musculus spasticity approach is a new method for administering injections to the correct point of the correct muscle. The clinical outcomes of this practical approach are not yet available in the literature. AIM: The purpose of this study was to evaluate the effects on spasticity and the functional outcomes of ultrasound guided botulinum toxin type A injections via the Euro-musculus spasticity approach to treat upper limb spasticity in post-stroke patients. DESIGN: Observational study. SETTING: Inpatient post-stroke patients. POPULATION: Twenty-five post-stroke patients with post-stroke upper limb spasticity were recruited. METHODS: The ultrasound-guided botulinum toxin type A injections were administered into the spastic target muscles using the Euro-musculus spasticity approach, and all of the patients were enrolled in rehabilitation programs after the injections. This research included the innervation zone and injection site figures and ultrasound images of each muscle in the upper limb. The degree of spasticity was assessed via the Modified Ashworth Scale and the upper limb motor function via the Fugl Meyer Upper Extremity Scale at the baseline and 4 and 12 weeks after the botulinum toxin type A injection. RESULTS: Significant decreases in the Modified Ashworth Scale scores of the upper limb flexor muscle tone measured 4 and 12 weeks after the botulinum toxin type A injection were found when compared to the baseline scores (P<0.025). When compared with the baseline Fugl Meyer Upper Extremity subgroup scores, the sitting position, wrist and total scores at 4 and 12 weeks were significantly improved (P<0.025). However, only the Fugl Meyer Upper Extremity hand scores were significantly improved 12 weeks after the injection (P<0.025). CONCLUSIONS: Ultrasound-guided botulinum toxin type A injection via the Euro-musculus spasticity approach is a practical and effective method for administering injections to the correct point of the correct muscle. Ultrasound-guided botulinum toxin type A injections combined with rehabilitation programs decrease spasticity and improve the upper extremity motor functions in stroke patients. CLINICAL REHABILITATION IMPACT: This new approach for ultrasound-guided botulinum toxin type A injection is very practical and effective method for upper extremity spasticity.

Comparison of splinting and Kinesio taping in the treatment of carpal tunnel syndrome: a prospective randomized study.

The aim of this study was to investigate and compare the effectiveness of splinting and Kinesio taping (KT) as forms of treatment for patients with mild to moderate idiopathic carpal tunnel syndrome (CTS) by evaluating the symptoms and measuring the range of function and electrophysiological findings. This single-blind, randomized, prospective study included 44 patients (58 hands) suffering mild to moderate idiopathic CTS according to nerve conduction studies (NCS). The patients were randomized into two groups and evaluated before treatment and 6 weeks after treatment by means of physical examination findings, NCS, and the Boston Carpal Tunnel Questionnaire (BCTQ) functional status and symptom severity scale scores. When the differences in both groups before and after treatment were compared, a significant improvement was observed in the KT group compared to the splint group in terms of electrophysiological changes, provocative test responses, BCTQ symptom severity, and functional status scores. KT may help prevent the disease from progressing further in mild and moderate idiopathic CTS when applied in time using the appropriate technique and be a good alternative to neutral splinting in terms of patient compliance.

Early rehabilitation results in a child who developed herpes simplex encephalitis.

In this case, a 4-year-old girl was admitted to the emergency service with the complaints of a sudden onset of fever, shortness of breath, jerking motions of the hands and feet and a sliding mouth. Her condition deteriorated, and she was kept under observation in the intensive care unit for 6 days. The Glasgow Coma Score of the patient was 1. Lumbar puncture revealed a white blood cell count of 0 and cerebrospinal fluid was positive for herpes simplex virus 1 and 2. Antiviral therapy was administered for 14 days. One month earlier, the patient had experienced a herpes labialis infection, which suggested herpes simplex encephalitis (HSE). Cranial magnetic resonance imaging indicated significant bilateral cerebral ischemic changes, which also supported suspicion of HSE. After antiviral treatment, the patient was referred to the department of physical therapy and rehabilitation. The Functional Independence Measure for Children (WeeFIM) scale was used to evaluate the patient. A 30-session rehabilitation program based on the Bobath concept of neurodevelopmental therapy was implemented. Before the treatment, the WeeFIM score was 20 points, and at its conclusion, the score was 88 points. The patient began to walk without limitation and the choreoathetosis was almost completely corrected. The patient was discharged with medical treatment and a home-based exercise training program.

Clinical Effects of Platelet-Rich Plasma and Hyaluronic Acid as an Additional Therapy for Talar Osteochondral Lesions Treated with Microfracture Surgery: A Prospective Randomized Clinical Trial.

BACKGROUND: Osteochondral ankle injuries commonly affect the dome of the talus, and these injuries are a common cause of athletic disability. Various treatment options are available for these injuries including intra-articular hyaluronic acid (HA) and platelet-rich plasma (PRP) injections. The purpose of this study was to compare the effects of HA and PRP as adjunct therapies after arthroscopic microfracture in osteochondral lesions (OCLs) of the talus. METHODS: In this prospective, randomized blinded study, 40 patients with talar OCLs in their ankle joints were treated with arthroscopic debridement and a microfracture technique. Thirteen randomly selected patients received PRP, 14 patients received HA, and the remaining 13 patients received saline as a control group. The participants were assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) and visual analog pain scale (VAS) scores after a 15.3-month (range, 11-25 months) follow-up. RESULTS: Postoperatively, all the groups exhibited significantly increased AOFAS scores and decreased VAS scores compared with their preoperative results (P < .005). The AOFAS scores were significantly increased in the PRP group versus the HA and control groups (P < .005), although the increased AOFAS scores in the HA group versus the control group were also significant (P < .005). Similar to the AOFAS scores, the decrease in the VAS scores was significantly lower in the PRP group versus the HA and control groups (P < .005). In addition, the HA group had significantly lower VAS scores than the control group (P < .005). CONCLUSION: Both PRP and HA injections improved the clinical outcomes of patients who underwent operation for talar OCLs in the midterm period and can be used as adjunct therapies for these patients. Because a single dose of PRP provided better results, we recommend PRP as the primary adjunct treatment option in the talar OCL postoperative period. LEVEL OF EVIDENCE: Level I, prospective randomized study.

Does renal dysfunction predict mortality after acute stroke? A 7-year follow-up study.

BACKGROUND AND PURPOSE: The purpose of this study was to investigate renal function as a long-term predictor of mortality in patients hospitalized for acute stroke. METHODS: This was a cohort study done in a Scottish tertiary teaching hospital. Participants included 2042 (993 male) unselected consecutive stroke patients (mean age, 73 years) admitted to hospital within 48 hours of stroke between 1988 and 1994. Follow-up was up to 7 years. Main outcome measure was all-cause mortality. RESULTS: The total number of deaths at the end of follow-up was 1026. Most subjects (1512) had creatinine <124 micromol/L. The mean calculated creatinine clearance was 54.8 mL/min (SD, 23 mL/min). Renal function indexes were analyzed by quartiles with Cox proportional-hazards model. Stroke survivors had higher calculated creatinine clearance and lower serum creatinine, urea, and ratios of urea to creatinine. Calculated creatinine clearance > or =51.27 mL/min significantly predicted better long-term survival in these stroke patients even after adjustment for confounders (age, neurological score, ischemic heart disease, hypertension, smoking, and diuretic use). Similarly, creatinine > or =119 micromol/L "relative risk (RR), 1.59; 95% confidence interval (CI), 1.32 to 1.92", urea 6.8 to 8.9 mmol/L (RR, 1.34; 95% CI, 1.09 to 1.65) or > or =9 mmol/L (RR, 1.74; 95% CI, 1.42 to 2.13), and ratio of urea to creatinine > or =0.08573 mmol/micromol (RR, 1.24; 95% CI, 1.03 to 1.50) remained significant predictors of mortality after adjustment for confounders. CONCLUSIONS: After acute stroke, patients with reduced admission calculated creatinine clearance, raised serum creatinine and urea concentrations (even within conventional reference intervals), and raised ratio of urea to creatinine had a higher mortality risk. This finding may be used to stratify risk and target interventions, eg, the use of angiotensin-converting enzyme inhibitors.