The effect of neuromuscular electrical stimulation on shoulder subluxation in stroke patients

Amaç: Bu çalışmada, kas-sinir elektrik uyarımının (KSEU) inmeli olgularda omuz subluksasyonu üzerine olan etkinliği araştırıldı. Hastalar ve Yöntemler: Akut ve kronik evreli inmesi olan 20 hasta (9 kadın, 11 erkek; ort. Yaş 58.32±11.07; dağılım 42-78) çalışmaya alındı. Olgularda ortalama hastalık süresi 5.47±3.17 ay (dağılım 2-12 ay) idi. Sublukse omuzlara KSEU dört hafta süreyle 25 dakika/gün uygulandı. Olgular tedavi öncesi ve sonrasında omuz eklem hareket açıklıkları, omuz grafilerinde subluksasyon ölçümleri, Brunnstrom evreleme, Ashworth skalası, fonksiyonel bağımsızlık ölçütü kullanılarak ve ağrı şiddeti ve hasta memnuniyeti açısından değerlendirildi. Bulgular: Tedavi öncesine göre, tedavi sonrasında aktif ve pasif olarak ölçülen fleksiyon, abdüksiyon, dış ve iç rotasyon derecelerinde istatistiksel olarak anlamlı artış elde edildi. Subluksasyon ölçümlerindeki sayısal azalmanın anlamlı olmadığı görüldü. Fonksiyonel bağımsızlık ölçütü, bunun alt birimi olan kişisel bakım, Brunnstrom değerlendirmesi ve ağrı sorgulamasında anlamlı iyileşme izlendi. Sonuç: Kas-sinir elektrik uyarımı, olumlu etkileri göz önüne alındığında, inmeli omuzlarda rehabilitasyon sürecinin bir parçası olabilir.Objectives: In this study we investigated the effect of neuromuscular electrical stimulation (NMES) on shoulder subluxation in stroke patients. Patients and Methods: We included 20 acute and chronic stroke patients (9 females, 11 males; mean age 58.32±11.07 years; range 42 to 78 years) into the study. The mean duration of disease was 5.47±3.17 months (range 2 to 12 months). Neuromuscular electrical stimulation was applied to the shoulders with subluxation for 25 minutes daily for four weeks. Evaluations were made before and after treatment with regard to range of motion of the shoulder, subluxation measured on radiographs, Brunnstrom levels, Ashworth scale, Functional Independence Measure, pain, and patient satisfaction. Results: After the treatment, statistically significant improvements were achieved in active and passive flexion, abduction, external and internal rotation; however, the numeric decrease in subluxation was not statistically significant. Functional Independence Measure scores, personal care levels, Brunnstrom scale scores, and the severity of pain improved significantly. Conclusion: Considering it favorable effects, NMES may be a part of rehabilitation process for shoulder subluxation in stroke patients

The Effects of Medical Treatments on Bone Mineral Density and Laboratory Data in Osteoporosis Patients

This study was carried out in order to compare the effects and relations between the scores of bone mineral density (BMD) values and laboratory data parameters such as serum Ca, Mg, P, ALP, creatinine, urinary Ca, creatinine, creatinine clearance before and after different treatments in patients with senil and postmenopausal OP. 251 female patients referred to OP outpatient clinic, were included in this study. The baseline demographic characteristics were inquired. BMD measurments were performed with DEXA and laboratory data related to bone metabolism such as serum Ca, P, Mg, ALP, creatinine; urinary Ca, creatinine, creatinine clearance, were obtained before and after treatment periods. The patients were divided into 7 groups according to their different medical treatments (Ca, Ca+Vit D, Ca+active Vit D, Calcitonin+Ca), Alendronate 10-70 mg+Ca, Risedronate+Ca regarding similar treatment durations. The comparisons between laboratory data and BMD values were investigated. According to the results statistical correlations were found; 1. Between P and femoral neck BMD (r=0.525, p=0.030), urinary Ca and ward’s triangle BMD (r=0.525, p=0.044) in the first group; 2. Between ALP and L2 BMD (r=0.652, p=0.04), Ca and L3 BMD (r=0.672, p=0.033) in the second group; 3. Between ALP and L2 BMD (r=-0.360, p=0.000), (r=-0.360, p=0.000), ALP and L3 (r=-0.229, p=0.029), urinary Ca and femoral neck BMD (r=0.238, p=0.029) in fourth group; 4. Between Mg and throcanteric BMD (r=0.599, p=0.024) in the sixth group; 5. Between P and femoral neck BMD (r=0.377, p=0.014), urinary Ca and L3 BMD (r=0.319, p=0.040) in seventh group. Up to day, there is no consensus about the choice of medical treatment for OP. It is reported that researches made on the effectiveness of the OP treatments often were condratiction to each other. We conclude that different kinds of medical treatments used in OP were effective on increasing BMD values, however there was not any evident effect on laboratory data parameters

Antibiotic overconsumption and resistance in Turkey

WOS: 000468097700002PubMed ID: 30844434The latest report of the OECD Health Policy Studies stated that in2015 the highest rates of antimicrobial resistance (around 35% inTurkey, Korea and Greece) were seven times higher than the lowestrates among its member countries. As the OECD country with thehighest rate of resistance (38.8%), despite a 15-year hospital anti-biotic restriction programme, Turkey is in urgent need of revisingits policies and drawing an effective action plan to reverse thecurrent trend. In this commentary we review previous measurestaken to tackle antimicrobial overuse and resistance in Turkey and discuss their effectiveness