Obstructive Sleep Apnea in Ischemic Stroke patients

OBJECTIVE: To investigate the prevalence of obstructive sleep apnea in patients with ischemic stroke and to evaluate the effectiveness of nasal continuous positive airway pressure treatment. METHODS: Overnight polysomnography was performed by a computerized system in 19 subjects with ischemic stroke. Patients with an apnea-hypopnea index > 5 were considered to have obstructive sleep apnea. The appropriate level of continuous positive airway pressure for each patient was determined during an all-night continuous positive airway pressure determination study. Attended continuous positive airway pressure titration was performed with a continuous positive airway pressure auto-titrating device. RESULTS: Obstructive sleep apnea prevalence among patients with ischemic stroke was 73.7%. The minimum SaO2 was significantly lower, and the percent of total sleep time in the wake stage and stage 1 sleep was significantly longer in patients with obstructive sleep apnea. In two patients with severe obstructive sleep apnea, we observed a decrease in the apnea-hypopnea index, an increase in mean wake time, mean SaO2, and minimum SaO2, and alterations in sleep structures with continuous positive airway pressure treatment. CONCLUSION: As the diagnosis and treatment of obstructive sleep apnea is of particular importance in secondary stroke prevention, we suggest that the clinical assessment of obstructive sleep apnea be part of the evaluation of stroke patients in rehabilitation units, and early treatment should be started

Prospective evaluation of free radicals and antioxidant activity following 6-month risedronate treatment in patients with postmenopausal osteoporosis

In addition to the well-described implications of estrogen deficiency in postmenopausal osteoporosis (PMO), free radicals are also effective on bone metabolism. The antioxidant vitamins C and E play an important role in the production of collagen, mesenchymal cell differentiation into osteoblasts, and bone mineralization. Therefore, the incidence of osteoporosis and the risk of fractures were decreased with vitamin C and E. It was proposed that free oxygen radicals are responsible for biological aging, atherosclerosis, carcinogenesis, and osteoclastic activity via their negative effects on the cell and DNA. In this study, we aimed to investigate and compare the levels of free radicals and serum antioxidant activity in patients with PMO and healthy subjects before and after six-month treatment with risedronate, which is an inhibitor of bone resorption. Twenty-three postmenopausal patients aged between 52–83 (mean [± standard deviation] 67.6 ± 8.17) with T scores below -2.5 in femur neck or L1-L4, and 23 postmenopausal healthy subjects were enrolled into the study. Patients who had received any medications within the last 6 months that could alter bone metabolism were excluded. Serum malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GPx) levels were analyzed in both groups. The patients with PMO were commenced on 5 mg of risedronate, 1,200 mg of calcium, and 800 IU of vitamin D daily. The patients were reevaluated at the end of the sixth month. MDA and SOD levels were similar in patients with PMO when compared to the healthy group before the treatment, while the GPx levels were lower in patients with PMO (P = 0.014). GPx (P = 0.028) and MDA (P = 0.04) levels were increased in patients with PMO after the treatment. In contrast, SOD levels were decreased when compared to the initial levels (P = 0.006). There may be an insufficiency in different steps of the enzymatic antioxidant systems in patients with PMO without treatment. We observed an increment in lipid peroxidation levels and GPx levels with risedronate. We think that the decrement in SOD levels may be related with the utilized antioxidants due to the increased free radicals and the compensatory increment in the other steps of the antioxidant system

Comparison of Interpolation Methods in the Diagnosis of Carpal Tunnel Syndrome

Diagnosis of carpal tunnel syndrome is based on clinical symptoms, examination findings, and electrodiagnostic studies. For carpal tunnel syndrome, the most useful of these are nerve conduction studies. However, nerve conduction studie can result in ambiguous or false-negative results, particularly for mild carpal tunnel syndrome. Increasing the number of nerve conduction studie tests improves accuracy but also increases time, cost, and discomfort. To improve accuracy without additional testing, the terminal latency index and residual latency are additional calculations that can be performed using the minimum number of tests. Recently, the median sensory-ulnar motor latency difference was devised as another way to improve diagnostic accuracy for mild carpal tunnel syndrome

Bilateral pan-plexus lesion after substance use: A case report.

Peripheral nervous system complications such as acute demyelinating polyradiculopathy and mononeuropathy may rarely develop after substance use. A 27-year-old man used illegal drugs the day before his admission to the emergency service. Initially, he was suspected for rhabdomyolysis, due to elevated blood urea nitrogen, creatinine, aspartate aminotransferase, alanine aminotransferase, myoglobin, and creatine kinase levels. On Day 4, generalized edema and flask paralysis were noted in both upper limbs. The patient was diagnosed with bilateral brachial pan-plexopathy based on electrophysiological study results. He underwent a rehabilitation program. After eight months, repeated electrophysiological study revealed a significant improvement in all bilateral upper limb muscles, except for the right abductor pollicis brevis and abductor digiti minimi muscles. The underlying cause of bilateral brachial pan-plexopathy was rhabdomyolysis secondary to substance use. In conclusion, substance use in patients with non-traumatic plexopathy should always be questioned

Changes in Serum and Urine N-Telopeptide Levels of Postmenopausal Osteoporotic Patients Within 6-months of Risedronate Treatment - Original Investigation

Aim: N-Telopeptides (NTX), which are known as bone turnover markers are being increasingly used in early diagnosis of osteoporosis, determining the fracture risk and following up of the treatment outcome. Material and Method: In this study serum and urine NTX levels of postmenapousal patients [ages 60-83 (mean 69.45), n: 11] with no previous treatment of osteoporosis are compared with the levels after 6-months of risedronate treatment and serum and urine NTX levels of the control group [ages 57-73 (mean 64.64), n: 11]. Results: Consequently serum NTX (sNTX) levels of postmenapousal patients before risedronate therapy were significantly higher then the sNTX levels of the control group. After risedronate therapy sNTX levels were significantly higher and urine (uNTX) levels were lower when compared with the NTX levels before treatment. Also either sNTX or uNTX levels before and after the treatment were positively and strongly correlated. Discussion and Conclusion: Eventually bone turnover markers carry much importance in diagnosis and follow-up the treatment. Also the strong correlation between levels of NTX before and after the treatment shows that the sensitivity and specifity of these methods are high. Therefore they can be used as an alternative and adjunct method to bone densitometry to assess the response to treatment, especially to demonstrate the early changes. (Osteoporoz Dünyasından 2006;12:55-9

Burden of chronic low back pain in the Turkish population

Amaç: Kronik bel ağrısının özellikle kayıp iş günleri ve dizabilite anlamında toplum üzerine maliyeti çok büyüktür ve giderek arttığı görülmektedir. Türkiye’de kronik bel ağrısının maliyeti tam olarak bilinmemektedir. Bu çalışmada kronik bel ağrılı hastalarda sağlık kaynaklarının kullanımı, iş gücü-üretim kaybı ve hastalığın toplam ekonomik yükünün araştırılması planlanmıştır. Gereç ve Yöntemler: Çalışma, Türkiye’nin 8 ayrı bölgesindeki fziksel tıp ve rehabilitasyon kliniklerine başvuran hastaların çok merkezli kesitsel araştırılması olarak planlanmıştır. Çalışmaya kronik bel ağrılı 18 yaş üstü 662 hasta dahil edilmiştir. Olguların sosyo-demografk verileri, son 6 ay içindeki sağlık kaynaklarının kullanımı, son 3 ay içindeki çalışabilme durumlarını içeren bir anket, fonksiyonel durumu için Roland-Morris Disabilite anketi, depresyon durumu için de Beck Depresyon Ölçeği dolduruldu. Kişinin kendisi, işvereni ve sağlık sistemi tarafından yapılan harcamalar hesaplandı. Doğrudan harcamaları poliklinik viziti, tanısal testler, medikal tedaviler, hastane bakımı, ortopedik yardımcı cihazlar, fzik tedaviler; dolaylı harcamaları ise üretim gücündeki azalma, raporlu günler, iş gücü kaybı ile ilgili veriler oluşturdu. Bulgular: Bel ağrısı için hasta başı yıllık doğrudan harcama 1080 TL, dolaylı harcama ise 5511 TL idi. Doğrudan maliyet hastalık şiddeti, süresi ve yaş ile korele bulundu. Dolaylı maliyet kadınlarda yüksekti. Sonuç: Özellikle iş günü ve iş gücü kaybına bağlı dolaylı harcamalar doğrudan harcamalardan çok daha fazla maliyetlidir.Objective: Chronic low back pain (CLBP) is a great economic burden to the society mainly in terms of the large number of the lost work days and disability, and it appears to be growing. The economic burden of LBP in Turkey is not known. This study aims to analyze the health care resource use, work and productivity loss, and health-related economics of CLBP in Turkey. Material and Methods: The study was designed as a multi-centered cross-sectional survey of patients in physical therapy and rehabilitation clinics from eight different regions of Turkey and 662 patients with CLBP over 18 years of age were included. Data on patient sociodemographics, disease-related healthcare resource use during the previous 6 months, inability to work during the last 3 months, Roland Morris Disability Index for the functional status, and psychological health with Beck Depression Scale were collected. Direct costs included medical visits, investigations, medications, hospitalizations, orthopedic aids, and physical therapy. İndirect costs were evaluated mostly with productivity loss. Results: The total annual direct costs for CLBP per patient were estimated at 1080 TL. The indirect costs were estimated at 5511 TL per patient. Direct cost was correlated with disease severity, duration, and age. Indirect cost was higher in women. Conclusion: The indirect costs for CLBP were signifcantly higher than the direct costs

Burden of chronic low back pain in the Turkish population

Amaç: Kronik bel ağrısının özellikle kayıp iş günleri ve dizabilite anlamında toplum üzerine maliyeti çok büyüktür ve giderek arttığı görülmektedir. Türkiye’de kronik bel ağrısının maliyeti tam olarak bilinmemektedir. Bu çalışmada kronik bel ağrılı hastalarda sağlık kaynaklarının kullanımı, iş gücü-üretim kaybı ve hastalığın toplam ekonomik yükünün araştırılması planlanmıştır. Gereç ve Yöntemler: Çalışma, Türkiye’nin 8 ayrı bölgesindeki fziksel tıp ve rehabilitasyon kliniklerine başvuran hastaların çok merkezli kesitsel araştırılması olarak planlanmıştır. Çalışmaya kronik bel ağrılı 18 yaş üstü 662 hasta dahil edilmiştir. Olguların sosyo-demografk verileri, son 6 ay içindeki sağlık kaynaklarının kullanımı, son 3 ay içindeki çalışabilme durumlarını içeren bir anket, fonksiyonel durumu için Roland-Morris Disabilite anketi, depresyon durumu için de Beck Depresyon Ölçeği dolduruldu. Kişinin kendisi, işvereni ve sağlık sistemi tarafından yapılan harcamalar hesaplandı. Doğrudan harcamaları poliklinik viziti, tanısal testler, medikal tedaviler, hastane bakımı, ortopedik yardımcı cihazlar, fzik tedaviler; dolaylı harcamaları ise üretim gücündeki azalma, raporlu günler, iş gücü kaybı ile ilgili veriler oluşturdu. Bulgular: Bel ağrısı için hasta başı yıllık doğrudan harcama 1080 TL, dolaylı harcama ise 5511 TL idi. Doğrudan maliyet hastalık şiddeti, süresi ve yaş ile korele bulundu. Dolaylı maliyet kadınlarda yüksekti. Sonuç: Özellikle iş günü ve iş gücü kaybına bağlı dolaylı harcamalar doğrudan harcamalardan çok daha fazla maliyetlidir.Objective: Chronic low back pain (CLBP) is a great economic burden to the society mainly in terms of the large number of the lost work days and disability, and it appears to be growing. The economic burden of LBP in Turkey is not known. This study aims to analyze the health care resource use, work and productivity loss, and health-related economics of CLBP in Turkey. Material and Methods: The study was designed as a multi-centered cross-sectional survey of patients in physical therapy and rehabilitation clinics from eight different regions of Turkey and 662 patients with CLBP over 18 years of age were included. Data on patient sociodemographics, disease-related healthcare resource use during the previous 6 months, inability to work during the last 3 months, Roland Morris Disability Index for the functional status, and psychological health with Beck Depression Scale were collected. Direct costs included medical visits, investigations, medications, hospitalizations, orthopedic aids, and physical therapy. İndirect costs were evaluated mostly with productivity loss. Results: The total annual direct costs for CLBP per patient were estimated at 1080 TL. The indirect costs were estimated at 5511 TL per patient. Direct cost was correlated with disease severity, duration, and age. Indirect cost was higher in women. Conclusion: The indirect costs for CLBP were signifcantly higher than the direct costs

Assessment of the Relationship Between Vitamin D Level and Non-specific Musculoskeletal System Pain: A Multicenter Retrospective Study (Stroke Study Group)

Objective: In this study, it was aimed to evaluate the relationship between vitamin D level and pain severity, localization and duration in patients with non-specific musculoskeletal pain. Materials and Methods: Patients who applied to physical medicine and rehabilitation outpatient clinics due to non-specific muscle pain in 19 centers in Turkey were retrospectively screened. Three thousand four hundred fourpatients were included in the study, whose pain level was determined by visual analog scale (VAS) and the painful region, duration of pain and vitamin D level were reached. D group was found to be D deficient (group 1) when 25 (OH)D level was 20 ng/mL or less and group D 2 (vitamin D deficiency) was higher than 30 ng/mL (group 3). The groups were compared in terms of pain duration, localization and severity. In addition, the correlations of pain localization, severity and duration with vitamin D levels were examined. Results: D vitamin deficiency was detected in 2202 (70.9%) of 3 thousand four hundred and four registered patients, and it was found that vitamin D deficiency in 516 (16.6%) and normal vitamin D in 386 (12.4%). The groups were similar in terms of age, body mass index, income level, duration of complaint, education level, family type and working status (p>0.05). There was no statistically significant difference between groups in terms of VAS, pain localization and duration scores (p>0.05). Conclusion: Our study shows that vitamin D deficiency in patients with nonspecific musculoskeletal pain is not associated with the severity and duration of pain