A Case Report of Probable Secondary Sarcopenia After Intensive Care Hospitalization.

Malnutrition, inflammation, comorbid diseases, and inactivity are known causes of sarcopenia. It results in clinical consequences like fractures, falls, low quality of life, cognitive dysfunction, and mortality. Especially in the treatment of patients with prolonged immobilization syndrome, management should not only focus on functional limitations but patients should also be evaluated and followed up for sarcopenia. In this case report, we present the management of probable secondary sarcopenia in the intensive care unit as a result of urosepsis and discuss it in the light of the literature.

Conservative Treatment in Adult Degenerative Scoliosis: a Prospective Cohort Study.

Background: Adult degenerative scoliosis (ADS) is a coronal deviation of the spine greater than 10° resulting from the progressive degeneration of the vertebral elements in middle age, which is a three-dimensional deformity. In this study, the effect of conservative treatment methods on pain, disability, and quality of life of patients with ADS was evaluated. Methods:Thirty females with ADS were included in the present study. Demographic characteristics, Cobb angles, Visual Analog Scale (VAS), Short Form-36 (SF-36), Scoliosis Research Society-22 (SRS-22) and Roland Morris Disability Questionnaires (RMDQ) were noted. Fifteen sessions of physical therapy (hotpack, TENS and ultrasound) and exercises were administered to all patients. All assessment scales were used for evaluation at baseline as well as one month and three months after treatment. Results:Visual Analog Scale scores statistically differed between the first, second and third measurements (p<0,001). There was a significantly improvement in RMDQ between periods of time (p<0,001). While the second assessment was significantly lower than the first measure (p=0,001), there was no difference between the third and second measures (p=0,496). Similarly, quality of life assessments (SRS-22, SF-36) significantly differed between the first and second assessments and continued at the third assessment. Conclusion:Given the difficulties of surgical treatment and patients' comorbidities, conservative treatment methods are becoming important for ADS. Non-surgical treatments for ADS should be taken into consideration to improve pain, disability and quality of life outcomes.

Lower Urinary Tract Symptoms in Patients With Chronic Low Back Pain: A Cross-Sectional Study.

INTRODUCTION:  This study aimed to determine the extent of lower urinary tract symptoms (LUTS) in patients with chronic low back pain (CLBP) and the relationship between LUTS and patients' clinical and functional factors. METHODS: Patients aged 40 to 80 who were admitted with CLBP were included. Demographic data and the duration of CLBP and LUTS were noted. Anteroposterior and lateral lumbar radiographs and lumbar MRI findings were recorded. Short Form 36 (SF-36) and the Oswestry Disability Index (ODI) were used for functional status assessment. For the LUTS evaluation, patients were asked to tick the symptoms from the list of LUTS prepared. RESULTS: We included 90 patients with CLBP. The frequency of urinary incontinence was 81.1%. The mean number of LUTS was 2.81±3.22. The LUTS rates were higher in patients with vertebral height loss (p = 0.03), with central (p = 0.02) and lateral spinal narrow canals (p = 0.03), and with facet hypertrophy (p = 0.04). The rates of LUTS were lower in patients with decreased lumbar lordosis (p = 0.02). The ODI and LUTS were found to be related (p = 0.01). The role limitations due to physical problems of the SF-36 subgroups and LUTS were significantly correlated (p = 0.01). CONCLUSION: The incidence of the coexistence of CLBP and LUTS is high. Patients cannot match and report LUTS among their complaints, so physicians should inquire about LUTS in patients with CLBP and carry out the appropriate diagnosis and treatment.

The relationship between severity of overactive bladder symptoms and cognitive dysfunction, anxiety and depression in female patients with multiple sclerosis: Running head: OAB-V8, BICAMS and HAD scale in MS.

BACKGROUND: Overactive bladder (OAB), cognitive dysfunction, depression and anxiety are common problems encountered in MS. This study was planned to investigate the relationship between the severity of OAB symptoms and cognitive function, anxiety and depression in MS. METHODS: 100 patients with MS diagnosis with OAB symptoms were recruited. OAB symptoms was assessed with the OAB-V8 questionnaire. Symbol Digit Modalites Test (SDMT), California Verbal Learning Test II (CVLT-II) and Brief Vasospatial Memory Test-Revised (BVMT-R) in BICAMS Battery were used to evaluate cognitive function. Depression and anxiety were assessed with the Hospital Anxiety Depression (HAD) Scale. RESULTS: The mean age of the patients was 40.9±12.3, the duration of the disease was 9.03±6.89 years, and the mean OAB-V8 score was 17.6±8.9. SDMT test (r=-0.299, p<0.01) showed a moderately significant, CVLT-II (r= -0.219, p<0.05) and BVMT-R (r=-0.218, p<0.05) tests showed a weakly significant negative correlation with OAB-V8 score. There was a moderate positive correlation between the OAB-V8 score and HAD-D (r=0.279, p=0.005) and HAD-A (r=0.318, p=0.001) scores. SDMT and BVMT-R scores were significantly lower in anticholinergic (Ach) drug users (especially oxybutynin users) compared to those who did not use Ach drugs. CONCLUSIONS: It has been observed that the severity of OAB symptoms is related to worsening of information processing speed and an increase in depression and anxiety. It has been determined that there is a significant effect on information processing speed, visual learning and memory in patients using Ach drugs, especially in those using oxybutynin, compared to those who do not use Ach drugs.

Pedobarographic Measurements of Rheumatoid Feet Compared with Clinical Parameters.

Objective: This study aimed to investigate the relationship between plantar pressure pedobarographic measurements and disease activity, radiological abnormalities, and foot indexes in patients with rheumatoid arthritis (RA). Methods: Sociodemographics, foot symptoms, anatomical distribution, pain intensity and duration, and podiatry services access data were collected. Disease activity scale of 28 joints (DAS28) was used for the disease activity, and Health Assessment Questionnaire (HAQ) was used for the functional status. Foot function index (FFI) was used to measure the impact of foot pathology on its function. The Modified Larsen scoring was used to assess radiological abnormalities. Pedobarographic measurements were used to analyze foot loading characteristics. Results: A total of 104 feet of 52 patients with RA was evaluated. DAS28 scores did not correlate with the plantar pressure values (p>0.05). A significant correlation was found between HAQ scores and right medial midfoot loading pressure (r=0.355; p<0.01). FFI scores were positively correlated with right lateral midfoot loading pressure (r=0.302; p<0.05). No relationship was found between Manchester Foot Pain and Disability Index and plantar loading characteristics. The radiological scores were correlated with left lateral hindfoot plantar pressure (r=0.286; p<0.05). Conclusions: Pedobarographic measurements can be considered as a follow-up evaluation tool for the evaluation of all foot parts (forefoot, midfoot, and hindfoot). Rheumatoid feet investigation showed that foot involvement is independent of the disease duration, whereas midfoot plantar pressures are associated with the body mass index. Additionally, DAS28 may fall short as a marker of disease activity because it neglects foot problems.

The Effect of Yoga Asana "Vrksasana (Tree Pose)" on Balance in Patients With Postmenopausal Osteoporosis: A Randomized Controlled Trial.

OBJECTIVE: In this study, the effect of the add-on effect of the Tree Pose (Vrksasana) on the balance of patients with postmenopausal osteoporosis was investigated. DESIGN: Thirty-two patients with postmenopausal osteoporosis were randomly assigned to conservative exercise group (30 mins/d for 12 wks) or Tree Pose-added exercise group (30-min conventional exercise + 2-min Tree Pose/d for 12 wks) by Microsoft Excel randomization option. The balance of the patients was evaluated with Berg Balance Scale, Timed Up and Go Test, single-leg standing test, tandem walk test, tandem stance test, and Korebalance static&dynamic balance tests at baseline, sixth week, and third month of the exercise program. RESULTS: There was no statistically significant difference on baseline data between groups. There was a statistically significant difference between the two groups in the sixth-week measurement of single-leg stance (P < 0.05). In the Berg Balance Scale, static balance test, dynamic balance test, and tandem walk test, a statistically significant difference was found among baseline, sixth-week, and 12th week measurements in both the exercise group and the Tree Pose-added exercise group. CONCLUSIONS: Gains in the static and dynamic balance of postmenopausal osteoporotic patients can be obtained by adding "Vrksasana" to conventional exercises.

Assessment of adult patients with cerebral palsy.

OBJECTIVES: The aim of this study was to evaluate health problems, accommodation, and mobility of adult patients with cerebral palsy (CP). PATIENTS AND METHODS: Between September 2018 and September 2019, a total of 70 adult CP patients (37 males, 33 females; mean age 29.4±10.2 years; range, 19 to 68 years) who were admitted to our clinic were included. Accommodation, education status, mental state, comorbidities, spasticity, contracture, deformity, and mobility of the patients were evaluated. RESULTS: Of the patients, 24.3% were diplegic, 21.4% were hemiplegic, 32.9% were tetraplegic, 15.7% were dyskinetic, and 5.7% had mixed form of CP. Among the patient, 38.6% had normal mental ability and 21.4% had severe mental retardation. A total of 92.9% of the patients were living with their family, 85.7% were unemployed, 10% were illiterate, and 21.4% had no health problems. Speech disorder was the most common health issue in 52.9% of the patients. Other health concerns included sensory problems, epilepsy, bladder/intestinal problems, nutritional problems, and respiratory and skin problems. The ratio of pain was 31.4%. Mild deformity was present in 54.3% of the patients, 43.7% were wheelchair-dependent, and 25.7% were Gross Motor Function Classification System (GMFCS) Level V. CONCLUSION: Recognition and understanding health problems and living conditions of adult patients with CP would be useful both in determining the treatment goals of pediatric CP patients and in improving the quality of life of adult CP patients.

Validity of the Korebalance® Balance System in Patients with Postmenopausal Osteoporosis.

OBJECTIVE: Balance is impaired in postmenopausal osteoporosis. Balance can be assessed with several tests and balance assessment systems. In our study, we investigated validity of Korebalance Balance System (KBS). METHOD: 52 postmenopausal osteoporotic patient evaluated with balance tests (Berg Balance Scale (BBS) and Time Up&Go Test (TUG)) and Korebalance Balance System. KBS is a balance evaluation and exercise system. The higher the score, the greater the deterioration in the balance. Static and dynamic balance evaluation results are recorded as score values. KBS, BBS and TUG compared with demographic and clinic parameters (age, 25OHvitD, menopausal age, fall history in last year, fracture history). RESULTS: According to Pearson r correlation analysis, Korebalance Dynamic Test (KDT) and BBS had moderately negative correlation (r=-.38, p<.01), KDT and TUG had moderately positive correlation (r=-.42, p<.01). According to Spearman rho correlation analysis, Korebalance Static Test (KST) and BBS had moderately negative correlation (r=-.30, p<.05). Age and KST (r=.33, p<.05), age and KDT (r=.31, p<.05) had moderately positive correlation. No significant correlation was found with other parameters. In discriminant validity, there was no correlation between other nonfunctional demographic and clinical parameters. CONCLUSION: Korebalance Balance System was found to be a convenient assessment tool with moderate convergent validity compared with BBS and TUG and has an excellent intraclass correlation.

Osteopathic manipulative treatment improves function and relieves pain in knee osteoarthritis: A single-blind, randomized-controlled trial.

OBJECTIVES: In this study, we aimed to compare the efficacy of osteopathic manipulative treatment (OMT) to exercise treatment in the knee osteoarthritis (OA). PATIENTS AND METHODS: A total of 100 patients (9 males, 76 females; mean age 54.8±8.5 years; range, 40 to 70 years) with Stage II-III bilateral knee OA enrolled to the study and randomized into two groups between January 2015 and June 2015. Group 1 performed exercise and received OMT and Group 2 performed exercise alone. We assessed the clinical parameters with Western Ontario MacMaster Questionnaire (WOMAC) pain score, WOMAC joint stiffness score, WOMAC physical function score, Visual Analog Scale (VAS) and 50-m walking time. All patients were assessed at the beginning of the study, just after the treatment, and four weeks after the treatment. RESULTS: There was no significant difference between groups in terms of physical examination and clinical assessment parameters before treatment. Functional improvement (p<0.05) and pain relief (p<0.05) were significantly higher in the exercise + OMT group. CONCLUSION: Based on our study results, OMT is a particular treatment used by osteopathic physicians to complement conventional treatment of OA of the knee. In addition to the conservative treatment, OMT can be used.

Economic burden of stroke.

OBJECTIVES: This study aims to estimate the annual economic cost per hemiplegic patient in Turkey. PATIENTS AND METHODS: Between September 2014 and December 2014, a total of 84 hemiplegic patients (53 males, 31 females; mean age 61.4±13.5 years; range 28-89 years) with stroke for 12 months were included in the study. Type of cerebrovascular accident and complications were evaluated. Hospital records and data from the relatives of the patients were used to calculate the cost. Annual costs were evaluated starting from first hospitalization. Direct costs were calculated with the sum of hospital care (acute care, diagnostic investigations, treatment and rehabilitation), medications, medical visits, outpatient rehabilitation and orthopedic aids. Indirect costs were calculated by taking the income loss due to absence from work into consideration. Prices of medical resources were obtained from the 2014 Healthcare Implementation Notification payment list. RESULTS: At the end of the study, the average direct cost and indirect cost per patient were calculated respectively as 10,594.90±6,554.20 Turkish liras and 9,357.10±10,195.60 Turkish liras (4,606.47±2,849.65 USD and 4,068.30±4,432.86 USD). We found a negative correlation between total cost and age (p=0.001), and a positive correlation with duration of hospitalization (p=0.001) and number of complications (p=0.049). We were unable to find any relation of cost with sex and cerebrovascular accident type. Spasticity (p=0.028) and epilepsy (p=0.037) being among the complications were observed to increase the cost. CONCLUSION: Stroke is an important economic burden for Turkish population. Preventive social measures are necessary to reduce this cost.

Rehabilitation outcomes in children with cerebral palsy during a 2 year period.

[Purpose] To observe motor and functional progress of children with cerebral palsy during 2 years. [Subjects and Methods] Pediatric cerebral palsy patients aged 3-15 years (n = 35/69) with 24-month follow-up at our outpatient cerebral palsy clinic were evaluated retrospectively. The distribution of cerebral palsy types was as follows: diplegia (n = 19), hemiplegia (n = 4), and quadriplegia (n = 12). Participants were divided into 3 groups according to their Gross Motor Functional Classification System scores (i.e., mild, moderate, and severe). All participants were evaluated initially and at the final assessment 2 years later. During this time, patients were treated 3 times/week. Changes in motor and functional abilities were assessed based on Gross Motor Function Measure-88 and Wee Functional Independence Measure. [Results] Significant improvements were observed in Gross Motor Function Measure-88 and Wee Functional Independence Measure results in all 35 patients at the end of 2 years. The Gross Motor Function Measure-88 scores correlated with Wee Functional Independence Measure Scores. Marked increases in motor and functional capabilities in mild and moderate cerebral palsy patients were observed in the subgroup assessments, but not in those with severe cerebral palsy. [Conclusion] Rehabilitation may greatly help mild and moderate cerebral palsy patients achieve their full potential.

A case of caudal regression syndrome: walking or sitting?

Caudal regression syndrome (CRS) is a congenital disorder which is seen vertebral anomalies in varying degrees from lower thoracic spineto the level of the coccyx. We present a case of CRS which is not intended operation for orthopedic deformities considering functionality. 2, 5 year-old girl referred to our clinic with complaints about walking disability, knee and foot deformities. Patient's mother with unregulated diabetes did not have a history of drug use, radiation exposure and serious illness during pregnancy. Diagnosis had been put during antenatal follow-ups. On physical examination, her lower extremities were hypoplastic and had no muscle activity. Her hips were flexed and abducted, but did not have contractures. Her knees had 75 degrees of flexion contractures with popliteal webs and feet had equinovarus deformity. Frog belly was present due to abdominal muscles weakness. Also hypoplasic labia majora has been identified. In lumbar MRI, spinal cord was terminated at 6th thoracic (T6) vertebrae and the last solid vertebrae level was at T10. Patient who has been following by urology with clean intermittent catheterization had also severe urological problems including horseshoe kidney, neurologic bladder, vesico-ureteral reflux and grade 2 hydronephrosis. Orthopedic consultation was made for her deformities. They decided that ambulation unexpected patient's knee flexion contractures were helping sitting balance. Because of this operation was not considered. Prognosis, treatment options, strength exercises for upper extremities, skin care were told to parents and patient was taken to follow. CRS is a rare congenital abnormality which is associated with orthopedic deformities, as well as urological, anorectal and cardiac malformations. Treatment requires a multidisciplinary approach. It should not be forgotten that purpose of rehabilitation is not to correct all deformities but increase the functionality of everyday life.

Effect of botulinum toxin type-A in patients with focal spasticity.

OBJECTIVE: To investigate the effect of botulinum toxin type-A (BTX-A) on spasticity and function in patients with focal spasticity. METHODS: Patients attended to the outpatient clinic of physical medicine and rehabilitation department with a diagnosis of focal spasticity and had BTX-A injections because of spasticty were evaluated for the study. Demographic data, exercise status, orthoses, drugs used for spasticity, functional status, stages of spasticity of muscles before and after 1st and 3rd months of BTX-A injection according to Modified Ashworth Scale (MAS) were evaluated retrospectively. MedCalc 11.6 statistical program was used for statistical analyses. Statistical significance was defined as p<0.05. RESULTS: Forty-nine patients with focal spasticity were recruited for the study (35 men, 14 women). Mean age of the patients was 21.59±20.09 years. The patients had cerebral palsy (CP, n=28), 19 had hemiplegia (n=19) and paraplegia (n=2). Forty-three patients were using orthoses and exercising regularly. Mean Pediatric Functional Independence Measurement (WeeFIM) scores of the patients with CP was 54.82±28.91 and according to the Gross Motor Function Classification System (GMFCS) the patients were in stages 2 (14%), 3 (46%), 4 (11%) and 5 (29%). Mean Functional Independence Measure (FIM) of hemiplegic and paraplegic patients was 80.80±20.88. Brunnstrom staging scores for upper extremity (3.52±0.96), hands (2.68±0.82), lower extremity (4.57±1.01) were calculated. MAS muscles demonstrated statistically significant decrease in spasticity at the end of first and third months (p<0.05). CONCLUSION: We saw a significant decrease in the spasticity of upper and lower extremities in patients with focal spasiticity who received BTX-A injections. We suggest that if BTX-A injections are supported with orthoses and exercise programs, then functional status of the patients would be better.

Bone mineral changes during pregnancy and lactation.

OBJECTIVE: Significant calcium transfer from the mother to the fetus and infant occurs during pregnancy and lactation, theoretically placing the mother at an increased risk for osteoporosis. The relationship between pregnancy, breast-feeding and low bone mass is controversial. In this study we aimed to elucidate the relationship between pregnancy, breast-feeding and bone mass in third trimester pregnants, at least 3 months lactating mothers, and healthy young nulliporous women by using quantitative ultrasonometry. METHOD: The study included 120 women divided in three groups: third trimester pregnants, at least 3 months lactating mothers and healthy young nulliporous women. Demographics, total lactation time, number of pregnancies, births and miscarriages-abortions were recorded. Study groups underwent quantitative ultrasonometry measurement at midtibial shaft. Values of the ultrasonometry variables were calculated and compared for groups. RESULTS: There were no significant differences among the groups with respect to parameters of age, age at menarche, smoking, alcohol intake and physical exercise in all of the three groups (p > 0.05). No differences were found among the three groups in analyzed variables, when comparing SOS, T- and Z-scores mid-tibial shaft quantitative ultrasonometry. CONCLUSION: No statistically significant associations were found between ultrasonometry variables and pregnancy, breast-feeding or nulliparity.

Sexual dysfunction in women with rheumatoid arthritis.

AIM: Rheumatoid Arthritis (RA) is a widespread disease which leads to various degrees of disability and profound impact on overall life quality of the patient with regard to social, economic, psychological and sexual aspects. It may be assumed that RA can affect sexual function. The aim of this study was to evaluate the sexual function in female subjects with RA. METHODS: A total of 186 married women (age range 30-60 years) were included in this study. Of the total participants, 104 were RA patients and 82 were healthy women. Hospital anxiety and depression scale (HADS), Health Assessment Questionnaire (HAQ) and Disease Activity Score (DAS) were used to evaluate the differences between the controls and patient group. Sexual functions were evaluated using the validated Female Sexual Function Index (FSFI). RESULTS: The mean age of the RA patients and controls was 46.71 ± 7.65 and 43.98 ± 7.97, respectively. According to the total sexual function score evaluation, 97 out of 104 women with RA (93.7 %) and in 53 out of 82 women in control group (64.6 %) were regarded as having sexual dysfunction (SD). There was significant difference between these two subgroups with regard to only depression factor. CONCLUSION: Current results have demonstrated that patients with RA have had a higher sexual dysfunction rate, when compared with the control group. SD may be related to perceived depression, which are frequently encountered conditions in patients with RA.