The effects of Covid-19 on physical medicine and rehabilitation in Turkey in the first month of pandemic

Objectives: The outbreak of novel coronavirus-2019 (COVID-19) has affected Turkey very seriously, as well as all around the world. Many urgent and radical measures were taken due to the high contagious risk and mortality rate of the outbreak. It is noteworthy that isolation recommendations and the provision of health services for pandemic have a negative impact on Physical Medicine and Rehabilitation (PMR) services. In this study, we aimed to evaluate the effects of COVID-19 on the PMR services and physiatrists immediately after the first month of pandemic in Turkey. Patients and methods: An online survey consisting of 45 items was sent to the members of the Turkish Society of Physical Medicine and Rehabilitation. The main goal of the survey was to evaluate the changes in the provided service of PMR and conditions of physiatrists one month after the first reported COVID-19 case in Turkey. Results: A total of 606 PMR specialists and residents responded to the survey. The mean number of the patients visited the outpatient clinics was 148.2 +/- 128.5 per week before the pandemic, it significantly decreased to 23.4 +/- 33.1 per week after the first month of the reported first COVID-19 case. Similarly, the mean number of the patients of inpatient service significantly decreased from 21.7 +/- 39.3 per week to 2.5 +/- 10.0 per week after the first month of the pandemic. Most of the residents (69%) reported that their training was seriously affected due to pandemic. From the economic aspect, 69.2% of the participants who were working at private hospitals reported a decrease in their monthly salary, and 21% of them were sent to an unpaid vacation. A total of 21.9% of private-practice institutions paused their services. During the first month, 46.9% of the participants were assigned to the different services such as COVID-19 inpatient service, emergency or COVID-19 outpatient clinics. According to the Republic of Turkey, Ministry of Health guideline and algorithm, 15.7% of the physicians were in the category of healthcare workers with suspected COVID-19. Conclusion: The COVID-19 pandemic affected seriously both the services and the PMR physicians as early as the first month. This effect is expected to become worse, when the duration of pandemic prolongs. Proper arrangements and measures should be planned to ameliorate the negative effects of the pandemic on the patients and PMR physicians

The Effect of Fracture on Quality of Life in Postmenopausal Osteoporotic Women - Original Investigation

Prolonged human life span and amelioration of the current health conditions brings up the risk of fracture related to osteoporosis as an important medical problem. In this study, we aim to study the effect of fracture on quality of life with 29 postmenopopausal women with fracture and 33 without osteoporotic fracture. Demographic data, height, maximum height, body weight, body weight at age 25, localization of fracture of the patients were recorded. All of the patients' bone mineral densities (BMD) were evaluated with Dual energy X ray absorbtiometri (DXA). For evaluating quality of life Short Form 36 (SF 36) survey was used. In this study there were no statistical differences between the 2 groups when their age, menarc age, menopause age, number of pregnancies, height, body weight, maximum height and body weight at age 25 were compared. There was statistical difference between the groups in their shortening of height. When BMD levels were compared with DXA it was noted that the T scores at femur neck area and lowest area of BMD were statistically lower in the group with fractures; however there was no statistical difference in T scores of L2-L4. When we compared the quality of life of the 2 groups using SF 36 there was no statistical difference. (Osteoporoz Dünyasından 2006; 12 (2): 31-34

Osteoporosis in Children with Cerebral Palsy

Immobilization, poor feeding skills and inadequate calcium intake, limited sun light exposure and anticonvulsant medication in children with cerebral palsy (CP) predisposes these children to osteoporosis. The aim of this study was to determine the bone mimeral density (BMD) in our group of children with CP, compare it with the control group and investigate the relationship of BMD with probable risk factors of osteoporosis. Twenty-three children with CP (mean age 9,15 ± 4,13 years, range 5-17 years) and 15 healthy children ( mean age 8,13 ± 2,82) were included in the study. The patient group was especially investigated for anticonvulsant medication, dietary habits, sunlight exposure and daily duration of ambulation. In physical examination clinical type of CP, muscle tonus and type of ambulation were recorded. The BMD of the children was measured with dual x- ray absorptiometry (DEXA Lunar) in lumbar region and total body. Lomber and total BMD in children with CP were lower than that of controls, but this result was not statistically significant. In the patient group BMD in the arms was higher (p< 0.05). Lomber and total BMD were lower in children with inadequate dietary calcium intake (p< 0.05). We concluded that osteoporosis and related risk of fractures should be taken into consideration when dealing with CP and more studies with larger groups of children should be planned

The Effects of Low-intensity Resistance Training with Blood Flow Restriction Versus Traditional Resistance Exercise on Lower Extremity Muscle Strength, Walking Capacity, and Balance in Ischemic Stroke Survivors: A Study Protocol for the BFR-Stroke RESILIENCE Trial

Aim: The purpose of this study will be to determine the effect of low-intensity resistance training with blood flow restriction (LIRT-BFR) on lower extremity muscle strength, balance, functional mobility, walking capacity, gait speed, anxiety, and depression in patients with stroke and to compare the results with high-intensity resistance training (HIRT). Methods: This will be a two-arm, single-blinded, randomized controlled trial (RCT) in which 32 ischemic stroke survivors will be randomized into two groups: the LIRT-BFR group and the HIRT group. Both groups will perform 3 sets of 6 resistance training for 40 minutes, 3 days a week, in addition to aerobic exercise for 5 weeks. In the LIRT-BFR group, blood flow to the active muscle was restricted by a BFR band (tourniquet) placed at the proximal end of the lower limbs. The 10-meter walk test, five-time sit-to-stand test, timed up and go test, 6-minute walk test, and Barthel index test will be the primary outcome measures. The secondary outcome measures include depression, anxiety, gait speed, stride length, cadence, adherence to treatment intervention, and adverse events. Conclusion: The results from this RCT will constitute an evidence-base for BFR training and its efficacy on lower limb strength, walking capacity, and balance performance in patients with stroke

Dual Etiologic Back Pain in Pregnancy: A Case Report with Lumbar Disc Herniation and Transient Osteoporosis of the Bilateral Hip

Low back pain in pregnancy is a common complaint. It has been reported that the pregnancy is an independent risk factor for lomber disc herniation and may worsen the existing herniation. Transient osteoporosis of the hip (TOH), is a rare, self-limiting and gestational disease of unknown cause. In this article, we report a case of acute lomber disc hernia and later bilateral temporal osteoporosis of the hip that was treated with conservative methods during the same gestational period. With this pathologic case it is emphasized that, two pathological phenomenon can be seen in the same patient at the same time. It should be kept in mind TOH and radiculopathy should be considered in the differential diagnosis in pregnant patients who complains back and hip pain