Dıagnostıc Utılıty Of The Medıan/Ulnar Nerve Cross-Sectıonal Area Ratıo Measured By Ultrasonography In Carpal Tunnel Syndrome

GİRİŞ: Bu çalışmanın amacı karpal tünel sendromlu (KTS) hastalarda ultrasonografik olarak ölçülen median sinir kesitsel alanının (m-KA) ulnar sinir kesitsel alanına (u-KA) oranının ( m-KA/u-KA) tanısal değerini saptamaktır. METODLAR: Toplamda elektrofizyolojik olarak KTS saptanan 50 hasta, KTS ile uyumlu semptomları olan ancak elektrofizyolojik olarak KTS saptanmayan 50 kontrol değerlendirildi. Her bireyin semptomlarının en şiddetli olduğu tek eli değerlendirmeye alındı. Katılımcıların demografik sorgulamaları, klinik değerlendirmeleri (nörolojik muayene, Tinel-Phalen testleri), Boston karpal tünel anketi ve ultrasonografik ölçümleri elektrofizyolojik inceleme parametreleri sonuçlarına kör bir araştırmacı tarafından yapıldı. Karpal tünel girişinde pisiform kemik hizasında m-KA ve u-KA ölçümleri yapıldı ve m-KA/u-KA oranı hesaplandı. BULGULAR: Karpal tünel girişinde m-KA için seçilen 9.95 mm² eşik değerine göre duyarlılık %92, özgüllük %42 saptandı. Seçilen 13.90 mm² eşik değerine göre ise duyarlılık %56, özgüllük %90 olarak saptandı. Karpal tünel girişinde m-KA/u-KA için seçilen 2.96 eşik değerine göre duyarlılık %86, özgüllük %38 ve 3.71 eşik değerine göre ise duyarlılık %52, özgüllük %90 olarak saptandı. SONUÇ: KTS nin ultrasonografik tanısında pisiform kemik seviyesinden bakılan m-KA/u-KA oranı ek bir yarar sağlamamıştır. Bu seviyeden ölçülen m-KA daha duyarlı ve özgül bir yöntem olarak saptanmıştır.INTRODUCTION: The aim of this study was to assess the diagnostic utility of the ultrasonographic ratio of median nerve cross-sectional area (m-CSA) and ulnar nerve cross-sectional area, the m-CSA/ u-CSA ratio, in carpal tunnel syndrome. METHODS: Patients (n=50) with positive symptoms and electromyography results of carpal tunnel syndrome (CTS) and control subjects (n=50) with positive symptoms but negative electromyography results of CTS were evaluated. The most symptomatic hand of each participant were included in the assesment. Demographic characteristics, clinical assessments (neurological examination, Tinel-Phalen tests), Boston carpal tunnel questionnaire and ultrasonography measurements of the participants were performed by an investigator blinded to the results of electrophysiological examination parameters. Ultrasonographic m-CSA and u-CSA measurements were made at the level of the pisiform bone in the carpal tunnel inlet, and m-CSA/u-CSA ratio was calculated. RESULTS: Using the m-CSA cut-off value of 9.95 mm² showed a sensitivity of 92 % and a specificity of 42%. Conversely, the cut-off value 13.90 mm² showed a sensitivity of 56% and a specificity of 92% in the diagnosis of CTS. Using the cut-off value 2.96 for the ratio of m-CSA/u-CSA showed a sensitivity of 86% and a specificity of 38% while using the cut-off value 3.71 showed a sensitivity of 52% and a specificity of 90% at the level of pisiform bone in the diagnosis of CTS. CONCLUSION: The ratio of m-CSA/u-CSA at the level of the pisiform bone did not provide an additional benefit for the diagnosis of CTS. Ultrasonographic m-CSA measured at the same level was found to be more sensitive and specific method

Diagnostic utility of the sonographic median to ulnar nerve cross-sectional area ratio in carpal tunnel syndrome

Background/aim: The aim of this study was to assess the diagnostic utility of the ultrasonographic ratio of median nerve cross-sectional area (m-CSA) to ulnar nerve cross-sectional area (u-CSA), the m-CSA/u-CSA ratio, in carpal tunnel syndrome (CTS). Materials and methods: Fifty patients with positive symptoms and electromyography results of CTS and 50 healthy matched control subjects were evaluated. Ultrasonographic m-CSA and u-CSA measurements of each participant were made at the level of the pisiform bone and the m-CSA/u-CSA ratio was calculated. Results: Using the m-CSA cut-off value of 11.95 mm2 showed a sensitivity of 80\% and a specificity of 80\% while using a cut-off value 2.95 for the ratio of m-CSA/u-CSA showed a sensitivity of 86\% and a specificity of 72\% in the diagnosis of CTS. Conclusion: The ratio of m-CSA/u-CSA at the level of the pisiform bone was not detected to be superior to m-CSA in the diagnosis of CTS

Does fear of activity predict exercise capacity in patients with coronary artery disease in both sexes? A cross-sectional multicenter study

Objectives: This study aimed to identify whether fear of activity predicts exercise capacity in patients with coronary artery disease (CAD) and whether there is a difference between sexes regarding this relationship. Patients and methods: One hundred ninety-seven patients (145 males, 52 females; mean age: 56.3 +/- 10.8 years; range, 22 to 80 years) with a diagnosis of CAD or cardiac event in the previous one to 60 months were enrolled in this cross-sectional multicenter study between November 2015 and February 2017. Demographic and clinical features were recorded. Fear of activity was assessed by the fear of activity scale in patients with CAD (FactCAD). A 6 -min walk test was used to assess exercise capacity. Results: Female participants were older, less educated, and less employed (p=0.045, p=0.048, and p0.001, respectively) than males. Prevalence of myocardial infarction was higher in males. Comorbidities were higher in females. Multiple linear regression predicted 6 -min walk distance (6MWD) based on FactCAD, sex, and education level with an r -squared of 0.321 (p0.001). Fear of activity had an effect on walking distance in males (each additional score of FactCAD predicts a decrease of 1.3 m in 6MWD), together with disease duration, presence of chronic pulmonary disease, and low back pain, whereas fear of activity was not a predicting factor on walking distance in females. Age, education, and presence of angina predicted 6MWD in females. Conclusion: This study emphasizes that fear of activity is one of the predictors of 6MWD in males with CAD, and its assessment is recommended as a possible barrier to rehabilitation

Evaluation of hepatitis serology and frequency of viral reactivation in patients with inflammatory arthritis receiving biologic agents: a multicenter observational study

To evaluate of hepatitis serology and reactivation frequency in patients with rheumatic disease receiving biologic agents. Our study included patients with inflammatory rheumatic diseases from 23 centers, who were followed up with biological therapy. Demographic and clinical characteristics of the patients, duration of drug use and hepatitis serology and the state of viral reactivation were analyzed. A total of 4060 patients, 2095 being males, were included in our study. Of the patients, 2463 had Ankylosing Spondylitis (AS), 1154 had Rheumatoid Arthritis (RA), 325 had Psoriatic Arthritis (PsA), and 118 had other inflammatory rheumatic diseases. When the viral serology of the patients was evaluated, 79 patients (2%) who were identified as HBs Ag positive, 486 (12%) patients who were HBs Ag negative and anti-HBc IgG positive and 20 patients (0.5%) who were anti-HCV positive. When evaluated on a disease-by-disease basis, the rate of HBsAg was found to be 2.5% in RA, 2% in AS and 0.9% in PsA. Viral reactivation was detected in 13 patients while receiving biologic agents. HBs Ag was positive in nine patients with reactivation and negative in four patients. Anti-HBc IgG, however, was positive. Six of these patients had AS, four had RA, and three had PsA. The development of hepatitis reactivation in 11.4% of HBs Ag positive patients and 0.82% of anti-HBc IgG positive patients due to the use of biologic agents is an important problem for this group of patients. Antiviral prophylaxis is recommended to be started especially in patients who are HBs Ag positive and who are using biologic agents due to viral reactivation. Therefore, it is important to carry out hepatitis screenings before biologic agent treatment and to carefully evaluate the vaccination and prophylaxis requirements