Evaluati̇on of the quadri̇ceps muscle group thi̇ckness and pennati̇on angle wi̇th ultrasonography i̇n rheumatoi̇d arthri̇ti̇s pati̇ents

Romatoid Artrit (RA) öncelikli olarak sinoviyal eklemleri etkileyen sistemik, kronik, inflamatuvar bir hastalıktır. Diz eklemi RA da sık tutulan ve fonksiyonel olarak kısıtlılığa yol açan tutulumlardan biridir. Ultrasonografi (USG) son yıllarda, pahalı olmaması, kolay uygulanabilir olması ile birçok kas iskelet sistemi patolojilerinin incelenmesinde giderek artan öneme sahip olmuştur. Çalışmada amaç romatoid artritli hastalarda kuadriseps femoris kas bölümlerinin kalınlık, pennat açılarınının değerlendirilmesi ve gözlemciler arasındaki güvenililirliğin araştırılmasıdır. Bu çalışmaya 30 RA tanısıyla takipli olan hasta ve kontrol grubu olarak en yaygın izlenen inflamatuvar artrit olmayan 30 diz osteoartritli (OA) hasta alınmıştır. Bütün hastaların dominant dizlerindeki kuadriseps femoris kas grubu kas kalınlıkları, pennat açıları, cilt altı yağ doku kalınlıkları; deneyimli ve deneyimsiz iki ayrı gözlemci tarafından ultrason ile incelenmiştir. Deneyimli gözlemci tarafından ayrıca dizin medial-lateral kolleteral ligaman kalınlığı ve ekojenitesi, femoral kıkırdak kalınlıkları, mevcut ise sinovyal hipertrofi, effüzyon ve dejenerasyon varlığı değerlendirilmiştir. Ultrason değerlendirmesinde; RA lı hastalar ile diz OA lı hastalar arasında sinovyal hipertrofide anlamlı fark saptanmazken; diz OA lı hastalarda effüzyon ve dejenerasyon bulguları anlamlı olarak daha yüksek saptanmıştır. Her iki grupta da femoral kıkırdak kalınlıkları, medial ve lateral kollateral ligaman kalınlıkları arasında anlamlı farklılık bulunmamıştır. RA ve kontrol grubu arasında kuadriseps femoris kas kalınlıkları ve pennat açıları arasında anlamlı farklılık saptanmamıştır. Cilt altı yağ doku kalınlığı, kas kalınlığı ve pennat açı ölçümlerinde gözlemciler arasında yüksek oranda korelasyon bulunmuştur. İleri zamanlarda ultrasonografik olarak değerlendirilen kas kalınlığının, kas gücünü göstermesi için elektromiyografi ya da dinamometre ölçümleri ile kıyaslanarak daha niceliksel çalışmalar yapılmalıdır.Rheumatoid arthritis (RA) is a systemic, chronic and inflammatory disease primarily affecting synovial joints. Knee joint is commonly involved in RA and is one of the involvements leading to functional disability. In recent years, ultrasonography (USG) has become very important in examination of various musculoskeletal disorders as it is cheap and easily applied. The purpose of this study is to measure the thickness and pennation angle of the quadriceps femoris muscle in patients with rheumatoid arthritis and to investigate the reliability in between examiners. 30 patients with RA and as the control group, 30 patients with knee osteoarthritis (OA), the most common non-inflammatory arthritis, were included in the study. Two different examiners, one experienced and one non-experienced, measured the thickness, pennation angle and subcutaneous fat tissue thickness of the quadriceps femoris muscle in the dominant knee of all participants by ultrasonography. The experienced examiner also evaluated the thickness and echogenicity of the medial-lateral collateral ligaments of the knee, femoral cartilage thickness, and synovial hypertrophy, effusion and degeneration if existing. Ultrasonography revealed no significant difference in synovial hypertrophy in between patients with RA and knee OA; nevertheless effusion and degeneration findings were found to be significantly higher in patients with knee OA. Two groups did not significantly differ from each other regarding femoral femoris muscle thickness and pennation angle were not found to be significantly different in between RA and control groups. Examiners were highly correlated in their measurements of subcutaneous fat tissue thickness, muscle thickness and pennation angle. In the future, quantitative studies comparing muscle thickness detected by ultrasonography to electromyography or dynamometer measurements in order to show muscle strength should be conducted

Alternative drying of sodium sulfate decahydrate (Na2SO 4·10H2O) with microwave energy

The anhydrous sodium sulfate (Na2SO4) is produced from the sodium sulfate decahydrate also called mirabilite (Na 2SO4·10H2O) by removing its crystal water. This provides advantages in reducing the transportation costs and in uses in industry. Mirabilite starts to dissolve in its crystal water (i.e. crystal structure decomposes and starts to release its crystal water) above 32.4°C. In industrial applications, to dry off the crystal water, sodium sulfate decahydrate is heated in steam tube rotary or fluidized bed dryers with air above about 150°C. However, drying in rotary dryers is slow due to limitations in mixing and low gas temperatures. Fluidized bed dryers cause dusting and powder formation as a result of attrition caused by collision of particles in the bed. In this investigation, microwave energy has been considered as an alternative approach to solve the problems with current drying processes. With this alternative dehydration process, anhydrous sodium sulfate has been produced successfully from the sodium sulfate decahydrate with no damage to the sodium sulfate crystals. Comparative results of dehydration of sodium sulfate decahydrate in the oven and with microwave energy will be presented as well

Facing the Pandemic: Burnout in Physicians in Turkey

OBJECTIVE: During the COVID-19 pandemic, physicians have been working for long hours, with the fear of contracting the disease and infecting their families. Therefore, there are great concerns about the mental health of physicians. In this research, we aimed to reveal the factors that affect the burnout among physicians working during the pandemic

A rare but mortal condition: case series of three COVID-19 patients with spontaneous rectus sheath hematoma

Coronavirus disease 2019 (COVID-19) could emerge not only as viral pneumonia but also as a cardiovascular disease. Thromboprophylaxis has been recommended by the current guidelines, especially COVID-19 patients who are hospitalized. On the other hand, these drugs might cause serious bleeding complications. Hereby, we aimed to report three cases with spontaneous rectus sheath hematoma (RSH) developed after being administered thromboprophylaxis for severe COVID-19 pneumonia. In this case series, we draw attention to the rare, but mortal complication of the COVID-19 thromboprophylaxis regimen