Effect of tele-yoga on aerobic capacity, respiratory muscle strength, and cognitive performance in patients with obstructive sleep apnea syndrome.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) causes a decrease in aerobic capacity, respiratory muscle strength, and cognitive function, negatively affecting health-related quality of life. OBJECTIVES: This study aimed to compare aerobic capacity, respiratory muscle strength, cognitive performance, functional capacity, sleep quality and daytime sleepiness in OSAS patients practicing and not practicing tele-yoga (TY). METHODS: 44 OSAS patients (40 M, 4F) were randomized into TY and control groups. TY group underwent live synchronous group-based TY sessions, 60 min/day, three days/week, for 12 weeks. Control group performed unsupervised thoracic expansion exercises at home 4 times daily for 12 weeks. The following were evaluated at baseline and at the end of the 6th and 12th weeks: inspiratory and expiratory respiratory muscle strength (MIP, MEP), cardiopulmonary exercise test, Corsi Block Tapping Test (CBTT) and Stroop TBAG test, six-minute walk test (6MWT), Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). RESULTS: TY significantly improved MIP, and exercise test parameters (VE, HRmax,%HR, heart rate recovery in the first minute and RQmax), CBTT (forward) and Stroop TBAG test scores (parts of 3,4,5) compared to the controls (p<0.05). There were no significant changes 6MWT in the TY group compared to the control group (p > 0.05). Sleep duration (min), sleep efficiency, sleep quality of PSQI and ESS score improved significantly in the TY group compared to the control group (p < 0.05). CONCLUSION: We suggest including TY intervention as a method of exercise in addition to CPAP treatments since it improves the health-related parameters of OSAS patients.

Is the proprioceptive neuromuscular facilitation technique superior to Shaker exercises in swallowing rehabilitation?

PURPOSE: This prospective study was planned to investigate whether the combined isotonic technique of proprioceptive neuromuscular facilitation (PNF) is superior to Shaker exercises in improving the function of swallowing muscles. METHODS: Fifty individuals (30 females and 20 males; mean age 68 ± 3.89 years) with swallowing difficulties were separated into two groups randomly. The treatment groups were Shaker and PNF groups, which performed these exercises three times in a week for6 weeks. Swallowing difficulties were determined with the Turkish version of the eating assessment tool (T-EAT-10). The 100 ml-water swallow test was used to measure capacity, volume, and speed of swallowing. Contraction amplitude changes used as a universal measurement of motor unit activity during the muscle action were measured with superficial electromyography. RESULT: After 6 weeks of exercise training, T-EAT-10 scores decreased in both groups (p < 0.001). Water swallowing capacity and volume improved in both groups (p < 0.001). There was no change in swallowing speed in both groups (p > 0.05). Maximal voluntary contraction values of suprahyoid muscles were higher in PNF than the Shaker group (p < 0.05). CONCLUSION: Both the types of exercise can be used in the rehabilitation of swallowing difficulties. However, the PNF technique increased the contraction amplitude values that occur during maximum contraction more than the Shaker exercises. Different functional evaluations are needed to determine the effectiveness of PNF on swallowing difficulty.

The apoptotic actions of platelets in acute ischemic stroke.

Stroke is a disease that affects the blood vessels that supply blood to the brain. Although platelets are implicated in the pathophysiology of stroke the mechanism is still not clear and there antiplatelet agents available for the prevention and treatment of stroke. We herein examined the relationship between the potential cytokine, TNF-α platelet activation and apoptosis in acute ischemic stroke patients. We selected 60 patients (mean age 57.9 ± 10.2 years) who had not taken any antiplatelet drugs for 14 days. A group of 45 participants (mean age 51.05 ± 9.07 years) were selected as the control group. For both the patients and for the control group, P-selectin (CD62p) and Annexin-V binding, cytochrome-c levels, caspase-3 gene expression and caspase-3 releasing and plasma TNF-α levels were measured in platelets. The results showed significant increase in plasma TNF-α and platelet Annexin-V, CD62p, cytochrome-c and caspase-3 gene expression in stroke patients compared to the control group. The data of this work suggests that inflammation may have a role in platelet apoptosis in stroke which may suggest a new aspect of the role of inflammation in the development of acute ischemic stroke.

The pressure angle of the median nerve as a new magnetic resonance imaging parameter for the evaluation of carpal tunnel.

OBJECTIVES: The purpose of this study was to compare the MRI findings of the wrists of patients with carpal tunnel syndrome (CTS) and controls. We present a new MRI parameter, the pressure angle of the median nerve, in CTS patients. PATIENTS AND METHODS: The study included 55 wrists, 36 of which were diagnosed with CTS and 19 healthy controls. All subjects underwent clinical, electrophysiological, and MRI evaluation. Clinical and electrophysiological findings were staged according to the degree of deficit. MRI parameters including median nerve diameter (MR1) and width (MR2) at the pisiform bone level; median nerve diameter (MR3) and width (MR4) at the hamate bone level; carpal arch width (MR5); carpal arch height (MR6); pressure angle of the median nerve (MR7); carpal tunnel diameter at the pisiform bone level (MR8); carpal tunnel diameter at the hamate bone level (MR9) and median nerve-flattening ratio were investigated. Eighteen operated wrists were evaluated 8 weeks after surgery. Correlation between the MRI parameters, EMG and clinical signs were evaluated. RESULTS: Among the 36 wrists with CTS, 5.6% were mild cases, 55.6% were moderate, and 38.9% were severe. Electromyography staging was as follows: 5.6% mild, 52.8% moderate, and 41.7% severe. A good correlation between the clinical and electrophysiological staging of the wrists with CTS was demonstrated (P=0.0001). Median nerve width and carpal tunnel diameter at the pisiform bone level were found to be significantly increased whereas median nerve diameter at the hamate bone level and pressure angle of the median nerve (PAMN) were significantly lower in CTS group in comparison to controls. After surgery, median nerve diameter and width at the pisiform bone level decreased whereas median nerve diameter at the hamate bone level increased. In addition, carpal arch height and PAMN were also found to be significantly increased (P=0.0001). The carpal tunnel diameter and median nerve-flattening ratio increased at the hamate bone level post-operatively (P=0.0001) with no change at the pisiform bone level. CONCLUSION: The pressure angle of the median nerve may prove useful in the assessment of idiopathic CTS, both before and after surgery.

Tumor necrosis factor alpha serum levels and inflammatory response in acute ischemic stroke.

OBJECTIVE: To assess the implication of tumor necrosis factor alpha (TNF-alpha) and interleukine-6 (IL-6) in acute ischemic stroke and to correlate this with lesion size, vascular risk factors, and neurological impairment. METHODS: We included 70 patients consecutively admitted to the Department of 1st Neurology, Haydarpasa Numune Educational and Research Hospital, Istanbul, Turkey, between September 2001 and April 2002, with first-ever ischemic cerebral infarction within the first 24 hours from onset. The TNF-alpha, IL-6, fibrinogen, C-reactive protein, erythrocyte sedimentation rate (ESR) and leukocytes were determined in plasma on admission. Neurological impairment was evaluated with the modified Rankin Scale. RESULTS: We found higher baseline levels of TNF-alpha and IL-6 in the plasma of patients with acute ischemic stroke and neurological impairment in comparison to control subjects. In the large infarct group, TNF-alpha, IL-6, low-density lipoprotein-cholesterol and fibrinogen were found significantly higher compared to the small infarct group. While an association between TNF-alpha and IL-6 values and lesion size were determined, no relation was found between localization and etiology. The TNF-alpha level was found to be in positive correlation with IL-6, fibrinogen, and ESR. The IL-6 level was found to be in positive correlation with ESR fibrinogen, and leukocytes. CONCLUSION: Inflammatory findings are associated with the early stage of ischemic stroke. The TNF-alpha and IL-6 were also higher in patients with clinical worsening. The release of proinflammatory cytokines after focal cerebral ischemia indicates a step leading to tissue necrosis or reflects the amount of ischemic brain injury, since the higher concentrations of TNF-alpha and IL-6 are found in patients with large infarctions.

Normative data for lateral femoral cutaneous nerve SEPs.

AIMS OF THE STUDY: To determine normative values for somatosensory evoked potentials (SEPs) of the lateral femoral cutaneous nerve (LFCN). METHODS: The LFCN was stimulated at two points, one located 1 cm lateral to the midpoint of a line joining the anterior superior iliac spine (ASIS) and the patella (31 subjects), and the other one located 12 cm distal to the ASIS (24 subjects). Recordings were performed at Cz' (2 cm behind Cz)-Fz. RESULTS: Reproducible SEPs were obtained in all but one of the 31 subjects to ASIS-patella midpoint (mean P1 latency: 33.2+/-3.5 ms, mean side-to-side difference: 2.0+/-1.6 ms) and in all but three of the 24 subjects to stimulation 12 cm distal to the ASIS (mean P1 latency: 30.9+/-3.3 ms, mean side-to-side difference: 2.2+/-1.7 ms). CONCLUSIONS: Reliable SEPs can be obtained to LFCN stimulation. It is easier and, therefore, more convenient to stimulate the ASIS-patella midpoint.

Ischemic stroke in the vertebrobasilar system. Risk factors, etiology, and localization.

OBJECTIVE: To investigate and determine the clinical findings, lesions, risk factors, and variety of etiology in Turkish patients suffering from vertebrobasilar ischemia. METHODS: The clinical, radiological, and prognostic features of patients with ischemic stroke in the vertebrobasilar system (VBS) are not homogeneous. The mechanism, localization, and severity of the vascular lesions and the presence of coexisting vascular risk factors influence the prognosis. The study included 134 patients with ischemic strokes in the VBS that were evaluated according to age, gender, clinical findings, risk factors, lesion localization, echocardiography, Doppler sonography, and cervical magnetic resonance angiography at Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey between 1998-2002. RESULTS: Hypertension, heart disease, smoking, diabetes mellitus, and hyperlipidemia were the most commonly observed risk factors. While infratentorial involvement was seen at a higher ratio (75.4%), acute multi-infarcts appearing simultaneously were mostly localized in the thalamus and the brain stem (18.7%). Large and small vessel disease incidences have been found in 32.8% and 20.1% of the patients. Cardioembolism with an incidence rate of 41.8% was the most frequent etiological cause in VBS ischemia. No significant meaning has been developed with age and gender as compared to the relationship between localization and etiological subgroups. CONCLUSION: The most common risk factors were hypertension and cardiac diseases, and the most common localization of the infarcts was the infratentorial region. The cerebellum was seen as the most coexisting localization with all multiple infarcts. Cardioembolism accounted for the largest etiological group in all localizations and in multiple infarcts.

Cobalamine deficiency associated with neuropathy and oral mucosal melanosis in untreated gluten-sensitive enteropathy.

A 32-year-old woman was admitted with complaints of difficulty in walking and hypoaesthesia and tingling in her legs. She had short stature and brown-black hyperpigmentation, cheliosis, dental irregularities and scars in the axillary regions. Neurological examination revealed mild, symmetric, predominantly distal weakness of the legs; deep tendon reflexes were depressed. There was glove-and-stocking decrease in pinprick and temperature perception but proprioception and light touch were normal. Investigations established a diagnosis of celiac disease; her neurological features improved on gluten-free diet, but oral pigmentation persisted.

Factor V Leiden mutation in cerebrovascular disease.

Several studies indicate a high prevalence of factor V Leiden mutation as the most frequent coagulation defect found in patients with venous thrombosis. The relationship between this mutation and cerebrovascular disease has not been established in adults. In this investigation, we studied 29 patients with ischemic stroke and 20 with intracerebral hemorrhage, all of whom were compared with 20 controls. A region of the factor V gene containing the Leiden mutation site was amplified with polymerase chain reaction and the presence of mutation was determined with restriction enzyme digestion. We found no evidence of an association between factor V Leiden mutation and ischemic stroke or intracerebral hemorrhage. There was no evidence of association in subgroup the analysis by age, smoking status, myocardial infarction, hypertension, diabetes mellitus, or coronary disease. Factor V Leiden mutation doesn't seem to be associated with a risk of cerebrovascular disease.

Relation of lipid and lipoprotein(a) to ischaemic stroke.

The relationship of lipids and Lp(a) to ischemic stroke hasn't been established yet. Our aim was to determine lipid profile and vascular risk factors in stroke patients and compare them with control subjects. Seventy-nine consecutive patients with ischemic stroke were analyzed by total cholesterol, HDL-C, LDL-C, triglyceride, Lp(a) and doppler ultrasonography and vascular risk factors were recorded. Thirty control subjects of same ages were compared with the patient group. Lp(a) and lipids were correlated with stroke subtype and carotid atherosclerosis. There was no statistical significance between patients and control subjects related to total cholesterol, triglyceride, HDL-C, LDL-C and Lp(a) (P>0.05). Atherotrombotic and lacunar strokes didn't show any difference correlated with lipids and Lp(a). Hypertension and diabetes mellitus were important risk factors with (OR=4.50, 95% CI=1.25-16.22) and (OR=4.43, 95% CI=1.79-10.93) respectively. These results were statistically significant (P<0.05). Total cholesterol (308.67+/-85.82) and Lp(a) (32.10+/-17.30) values showed statistical significance (P<0.05) in patients with marked stenosis when compared with patients of normal doppler ultrasonography. Hypertension and diabetes mellitus were found as independent risk factors for ischemic stroke. Lipids and Lp(a) were not independent for atherotrombotic and lacunar stroke. Lp(a) concentration and carotid atherosclerosis in ultrasonography were associated significantly.