Health status, coronaphobia, quality of life, anxiety and depression in patients with lymphedema during COVID-19 pandemic.

Covid-19 has physical damage as well as serious impact on the mental health in the community. Symptoms such as anxiety, depression, fear, stress, and sleep problems were more commonly reported during Covid-19 pandemic. The aim of this study was to assess the health status, psychological conditions, quality of life, and possible risk factors of patients with lymphedema during the pandemic. The study included male and female patients aged ≥18 years with primary or secondary upper or lower extremity lymphedema (stage 1, 2, or 3) who were followed in our outpatient clinic. The patients were interviewed by phone. Health and social status were examined using a questionnaire, Covid-19 phobia was assessed using Covid-19 Phobia Scale (C19P-S), and quality of life was assessed using Lymphedema Quality of Life Questionnaire Arm or Leg (LYMQOL). Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale (HADS). The HADS scores showed that 35% of the patients had severe risk for depression and 10% had severe risk for anxiety. Factors with negative effect on HADS were lower education level, sedentary lifestyle, failure to perform lymphedema exercises, weight gain, and lymphedema duration. The C19P-S scores were higher indicating greater phobia in the overall score and subscores in patients with primary lymphedema and secondary lymphedema without malignancy, younger patients, those who are not able to walk regularly, and those who are not able to perform self manual lymphatic drainage (self-MLD). Factors with negative effects on LYMQOL were stage 3 lymphedema, female gender, younger age, and longer disease duration. Patients who performed regular self-MLD and lymphedema exercises demonstrated positive effects on LYMQOL. The results of this study suggest that patients with lymphedema affected by the COVID-19 pandemic are mostly younger patients, individuals with primary lymphedema, individuals with non-malignant etiology, individuals who unable to perform regular walking, and those unable to perform self- MLD.

Artemisinin attenuates doxorubicin induced cardiotoxicity and hepatotoxicity in rats.

We investigated the effects of artemisinin on doxorubicin (Dox) induced heart and liver pathology in rats. We divided 49 male rats into seven groups: group 1 was the untreated control. Dox was administered intraperitoneally to groups 2, 3 and 4 on day 1. Artemisinin was administered by gavage to groups 3 and 6 at a dose of 7 mg/kg, and to groups 4 and 7 at a dose of 35 mg/kg for 14 days. Group 5 was given only 0.9% NaCl orally for 14 days. At the end of the study, heart and liver samples were collected for histopathology and immunohistochemistry. Hyperemia and slight hemorrhages were observed in both livers and hearts of rats treated with Dox only. Significant increases in caspase-3, TNF-α, iNOS and NF-κB expression were observed in the myocardial cells and hepatocytes of group 2. Significant reductions in caspase-3, TNF-α, iNOS and NF-κB expression were observed in groups 3 and 4 following artemisinin treatment compared to group 2. Artemisinin may exert protective effects against Dox induced cardiotoxicity and hepatotoxicity in rats.

Reliability of the Modified Ashworth Scale and Modified Tardieu Scale in patients with spinal cord injuries.

STUDY DESIGN: Psychometrics study. OBJECTIVES: To assess the reliability of the Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS) in patients with spinal cord injuries (SCIs). SETTING: Inpatient rehabilitation clinics at two state hospitals. METHODS: The study included 65 participants aged between 18 and 88 years with SCI with spasticity. All participants were at least 6 months after injury and had an American Spinal Injury Association Impairment Scale grade of A-D. The MAS and MTS scores were collected from the right hip adductor and hip extensor muscles, right knee extensor and knee flexor muscles and right plantar flexor muscles. Each participant was assessed twice by two experienced physiatrists 1 week apart. The raters were blinded to each other's scores. RESULTS: Inter-rater and test-retest agreement for the MAS scores (κ=0.531-0.774) was moderate to substantial. Inter-rater and test-retest agreement for the MTS X scores (κ=0.692-0.917) was substantial to almost perfect. Inter-rater reliability and test-retest reliability of the MTS R2-R1 was excellent (intra-class correlation coefficient (ICC) 0.874-0.973, confidence interval (CI): 0.79-0.98) for all muscles tested. Inter-rater reliability of the MTS R2 for the hip adductor and knee extensor muscles was poor (ICC 0.248, CI: -0.00 to 0.47 and ICC 0.094, CI: -0.16 to 0.34, respectively). The test-retest reliability of the MTS R2 was also poor for the knee extensor muscles (ICC 0.318, CI: -0.06 to 0.53). CONCLUSION: MAS has adequate reliability for determining lower-extremity spasticity in patients with SCI. The demonstration of excellent inter-rater reliability and test-retest reliability of the MTS R2-R1 suggests its utility as a complementary tool for informing treatment decisions in patients with SCI.

Effect of intravenous zoledronic acid infusion on electrocardiographic parameters in patients with osteoporosis.

We evaluated the effects of zoledronic acid (ZA) therapy on electrocardiographic (ECG) parameters for the first time in the literature. Measurements were performed on ECGs obtained before and after ZA infusion on the same day as well as 1 month after the infusion. ZA infusion did not have any short- or long-term effect on any parameter that might be associated with the tendency for atrial fibrillation or ventricular arrhythmias. INTRODUCTION: The aim of the present study was to evaluate the early and late effects of ZA therapy on ECG parameters which might be associated with the tendency for atrial and ventricular arrhythmias. METHODS: Consecutive patients with osteoporosis who were admitted to our clinic between December 2013 and December 2014 and who were scheduled to receive ZA infusion constituted our study population. Twelve-lead surface ECGs were obtained from all patients before and after ZA infusion on the same day as well as 1 month after the infusion. All ECG parameters were measured and compared with each other for each patient. RESULTS: Data of 100 patients were used in the analysis (9 male; 70.5 ± 11.6 years of age). There were no significant differences between repeated measurements regarding pmax, pmin, and p dispersion values. QT max and QT min values were significantly increased after infusion; however, there were no significant changes in QT dispersion, Tp-e interval, and Tp-e dispersion values. CONCLUSIONS: ZA infusion did not affect P wave dispersion both at the immediate post-infusion period and 1 month after infusion. QT values were significantly increased early after ZA infusion; however, there were no significant differences in parameters reflecting disparity of ventricular recovery times and transmural dispersion of ventricular repolarization. Based on these observations, it may be suggested that ZA infusion did not have any short- or long-term effect on any parameter that might be associated with the tendency for atrial fibrillation or ventricular arrhythmias.

Idiopathic Hypoparathyroidism Mimicking Ankylosing Spondylitis: A Case Report.

Idiopathic hypoparathyroidism, inadequate secretion of parathyroid hormone of unknown etiology, may mimic ankylosing spondylitis both clinically and radiologically. Spinal complaints may be the first sign of any endocrinological disorder.

Sacroiliitis or insufficiency fracture?

Sacral stress fracture and sacroiliitis are two conditions that present with pain. Sacral stress fractures are a rare cause of lumbar and hip pain. Sacral insufficiency fractures are a type of sacral stress fractures. Sacroiliitis represents inflammation of the sacroiliac joints. Coexistence of sacroiliitis and sacral insufficiency fracture (SIF) has not been reported before. Case 1: A 39-year-old woman reporting inflammatory back pain. Imaging revealed bilateral chronic sacroiliitis and bilateral SIF. Case 2: A 31-year-old woman presenting with left hip and inguinal pain. Imaging revealed left sacroiliitis and ipsilateral SIF. Calcium and vitamin D supplementation together with nonsteroidal anti-inflammatory drug (NSAID) treatment were given. Sulfasalazine was added to the treatment of the second patient who developed peripheral arthritis during follow-ups. Early diagnosis is best made with magnetic resonance imaging (MRI) since roentgenograms may be negative initially. Furthermore, MRI findings of both entities share common features leading to a diagnostic dilemma. Interpretation of radiological findings assisted by detailed history and clinical findings is crucial for diagnosis and treatment.

The next step in the treatment of persistent temporomandibular joint pain following arthrocentesis: a retrospective study of 18 cases.

Temporomandibular joint disorders affect a big portion of the population. There are a variety of treatment methods currently in use. Conservative treatment modalities are followed by more invasive approaches like arthrocentesis or arthroscopy. The aim of the study is to compare the effects of intra-articular tenoxicam injection and arthrocentesis plus viscosupplementation on patients in which a previous arthrocentesis plus viscosupplementation has failed to relieve pain and restore function. The study group consists of 18 TMJs in 16 patients (15 female and 1 male) and the patients were randomly divided into two groups as the arthrocentesis plus viscosupplementation group (n: 8) and tenoxicam injection (n: 10). 20 mg of tenoxicam was injected to the upper compartments of 10 joints without arthrocentesis. The other 8 joints were treated with a second arthrocentesis and sodium hyaluronate injection. VAS scores and maximum mouth opening with and without assistance were recorded in the post operative first week, first month and third month. The results show that there is little benefit in using relatively conservative methods once an arthrocentesis together with viscosupplementation has failed to relieve the patients pain. It is concluded that more invasive procedures should be considered for the patients who do not benefit from arthrocentesis.

Prognostic indicators of the outcome of arthrocentesis with and without sodium hyaluronate injection for the treatment of disc displacement without reduction: a magnetic resonance imaging study.

This study analysed the prognostic factors for successful arthrocentesis with and without sodium hyaluronate (SH) injection for the treatment of temporomandibular joint (TMJ) disc displacement without reduction (DDwoR) using clinical and radiological results. 29 TMJs in 25 patients with DDwoR were included. Patients were treated with arthrocentesis or arthrocentesis followed by intra-articular (i.a.) injection of SH. Treatment was evaluated for postoperative range of maximum mouth opening and the degree of postoperative pain on a VAS. Prognostic factors analysed were age, sex, duration of locking, trauma history, previous TMJ treatment, depression, bruxism, malocclusion and missing teeth. Degenerative changes were evaluated as probable prognostic factors. After treatment, 24 joints (83%) fulfilled the criteria for success. Duration of locking and present preoperative degenerative changes were the most significant factors for treatment outcome. The results suggest it is sufficient to use only arthrocentesis in patients without preoperative degenerative changes and arthrocentesis with SH in patients with degenerative changes on their preoperative MRIs, but because there were some significant differences between the two groups preventing the authors from comparing them statistically, they cannot come to that conclusion. To clarify the use of SH in such cases, standardized study groups are necessary for future studies.

Yoga might be an alternative training for the quality of life and balance in postmenopausal osteoporosis.

AIM: Osteoporotic vertebra and hip fractures are major causes of dysfunction, disability, mortality and impaired life quality in the ageing population. In the postmenopausal period, exercises prevent rapid bone loss and increase muscle strength, mobility and flexibility thereby decreasing the risk of falls and fractures. Yoga exercises, which have been an inseparable part of Eastern culture for hundreds of years, are now being used in the field of osteoporosis rehabilitation. Yoga has a positive effect on balance, posture, flexibility, and life quality resulting from its effects on balance, stretching, relaxation and strengthening. The aim of this study was to evaluate the effect of yoga exercises in postmenopausal osteoporotic women on balance and life quality and to compare the results with a classic osteoporosis exercise program. METHODS: Twenty-six postmenopausal osteoporotic women over 55 years of age were included in the study. A neuromuscular test battery and the QUALEFFO as a life quality index were used for the assessment of balance and life quality, respectively. RESULTS: The results showed that yoga education has a positive effect on pain, physical functions, social functions, general CONCLUSION: In conclusion, yoga appears to be an alternative physical activity for the rehabilitation of osteoporotic subjects.

Intra-articular injection of tenoxicam following temporomandibular joint arthrocentesis: a pilot study.

This study examined the clinical and radiological effects of intra-articular tenoxicam injection following arthrocentesis and compared them with arthrocentesis alone in patients with disc displacement without reduction (DDwoR). 24 temporomandibular joints (TMJs) in 21 patients with DDwoR were studied. Patients were divided randomly into Group A in which only arthrocentesis was performed (14 TMJs in 14 patients) and Group AT which received arthrocentesis plus intra-articular injection of tenoxicam (10 TMJs in 7 patients). Patients were evaluated before the procedure, on postoperative day 7, then 2, 3, 4 weeks, and 2, 3, 4, 5, 6 months postoperatively. Intensity of joint pain was assessed using a visual analog scale. Maximum mouth opening was recorded at each follow-up. TMJ sounds and palpation scores were noted as positive or negative. Magnetic resonance imaging (MRI) was performed before and 6 months after treatment in both groups. Disc form, disc location during neutral position, reduction with movement, joint effusion, structures of the articular surfaces, and bone marrow anomalies were evaluated all in MRIs. Both treatments succesfully increased maximum mouth opening and reduced TMJ pain; there were no complications. Difference between the groups was not statistically significant and a larger controlled study is necessary to clarify this use of tenoxicam.

The relationship between benign joint hypermobility syndrome and carpal tunnel syndrome.

Benign joint hypermobility syndrome (BJHS) is defined as the presence of musculoskeletal symptoms in persons with generalized joint laxity in the absence of systemic rheumatologic disease. There is an association between soft tissue rheumatism, entrapment neuropathies, and BJHS. The purpose of the study was to identify the relationship between BJHS and carpal tunnel syndrome (CTS). Ninety patients were included in the prospective controlled study. All selected participants were referred to our electrophysiological laboratory with clinical diagnosis of CTS. Subsequently, subjects were divided into two groups as group I and II. Group I included patients with CTS and group II had patients without CTS based on electrophysiological findings. All subjects were assessed for existing BJHS by using the Brighton 1998 criteria. Fifty-five patients were recruited into group I (CTS) and 35 subjects were in group II. The mean age in group I and II was 49.5+/-10.8 and 40+/-9.9 years, respectively. The subjects in group II were younger than those in group I (p<0.05). The mean Beighton score was 2.04+/-2.7 and 1+/-1.68 in groups I and II, respectively. In patients with CTS, BJHS rate was markedly higher than those in patients without CTS with respect to Brighton 1998 criteria (p<0.0001). There was a positive correlation between CTS and BJHS (r=0.59, p=0.0001). Consequently, we suggested that BJHS could be a predisposing factor for CTS or vice versa.

Frozen shoulder development secondary to proximal humerus fracture and supraspinatus tendon tear following electrical injury.

Musculoskeletal injury incidence occurring as a result of low voltage electrical accidents is extremely rare. In the present paper, we report 2 cases of low voltage electrical injuries with frozen shoulder development secondary to proximal humerus fracture and supraspinatus tendon tear. Magnetic resonance imaging, taken due to persistence of shoulder pain and reduction of shoulder joint mobility in cases monitored because of proximal humerus fracture associated with electrical injury, revealed a tear of supraspinatus tendon. Moreover, frozen shoulder status was clinically established in both of the cases. The cases were treated with an appropriate physical therapy and rehabilitation program. Supraspinatus tendon tears accompanying proximal humerus fractures should not be overlooked in low voltage electrical injuries and development of frozen shoulder should be avoided by applying the proper physical therapy and rehabilitation program.

Radiological evaluation of sinus lift operation: what the general radiologist needs to know.

This article provides an overview of the sinus lift operation, including radiographic evaluation of the procedure. Plain radiographs such as dental or panoramic radiographs have conventionally been used to measure the bone volume in the operation site, but full three-dimensional assessment of the region before and after the sinus lift operation is advisable both to allow planning of the lift and to see the results of it. The general radiologists sometimes misinterpret the graft material used in sinus lift cases as odontogenic tumour or some other pathology. The aim of this article is to put an end to this wrong interpretation and to familiarize the general radiologist with pre-operative and post-operative imaging of sinus lift cases.