Rehabilitation of Guillain Barre syndrome

Guillain Barre Sendromu (GBS) periferik sinir sisteminin akut otoimmün bir hastalığıdır. Çoğu hastada duyu kaybı ile birlikte hızla gelişen kuvvetsizlik başlıca özelliğidir. Plato faz sonrasında başlayan spontan iyileşme her zaman tam değildir. Hastaların yaklaşık olarak %40'ı rehabilitasyon gerektirir.Uzun dönem özürlülüğün en yaygın sebebi distal kuvvetsizliktir. Ventilatör desteği rehabilitasyon süresinde uzama ve maliyetinde artma ile koreledir. Rehabilitasyonu etkileyen diğer faktörler disotonomi, kraniyal sinir tutulumu ve komplikasyonlardır. Deafferantasyon ağrısı iyilleşmenin erken döneminde yaygındır. Derin ven trombozu, eklem kontraktürleri, immobilizasyon hiperkalsemisi, anemi ve bası yarası gibi komplikasyonlar gelişebilir. Motor üniti etkileyen aşırı yüklenme klinik olarak paradoksal güçsüzlükle birliktedir ve iyileşmeyi engelleyebilir. Guillain Barre Sendromunun neden olduğu özürlülüğün uzun dönem sonuçları çok az bilinmektedir. Rehabilitasyonda postpolio ve spinal kord yaralanması için yapılan benzer çalışmalara başlanmalıdır.Guillain Barre Syndrome is an acute autoimmune disease of peripheral nervous system. The main feature is rapidly evolving motor weakness combined in many patients with sensory loss. After a plateau phase, spontaneus recovery starts, but it is not always complete. Approximately %40 of patients who are hospitalized with GBS will require admission to inpatient rehabilitation. Ventilatory support has been correlated with longer length of stay and increased cost for inpatient rehabilitation. Other factors that affect rehabilitation are dysautonomia, cranial nerve involvement and various medical complications. Deafferent pain syndrome is common in early stage of recovery. Multipl medical complications, including deep venous trombosis, joint contractures, hypercalcemia due to immobilization and pressure sores may develop. Overfatiguing the affected motor unit has been clinically associated with paradoxical weakness and may impede recovery. Little is known known about the long term outcomes of disability caused by GBS. Rehabilitation programme is similar to that performed in postpolio syndrome and spinal cord injury

The effects of gestationalweight gain and maternal body mass index discrepancy on all stages of labor

Objective: To investigate the effects of maternal body mass index (BMI) and total weight gain during the pregnancy (WGDP) on all stages of labor. Material and Methods: This is a prospective case-control study carried out at a tertiary referral hospital during 1-year period of time. We divided study population into 4 groups according to BMI and classified women according to WGDP; inadequate, optimum, excessive. Then we assessed the maternal characteristics, cesarean rate, all variables of labor stages, delivery complications, operative delivery rates, and interventions such as; induction rate and episiotomy. Results: A total of 523 women were included in the study [n=55 (10.5%) cesarean section and n=468 (89.5%) vaginal delivery]. There were 435 pregnant Turkish women and 88 Syrian Refugees in the study population. Younger maternal age and need for episiotomy was more common in low-weight group than others. All stages of labor except transition stages (duration between 7 and 10 cm of cervical dilatation) was longer in obese group (222.9±35.6 min, 195.8±29.6 min, 200.6±30.4 min, 255.8±38.2 min in group 1,2,3 and 4, respectively) (p<0.05). We found no statistically significant effect of weight gain on the duration of labor. Conclusion: Either low and high pre-gestational BMI are found to lead to increased risk of adverse labor results in compatible with literature. Therefore, professionals should support weight loss or gain to achieve optimal BMI in women planning pregnancy

Measurements of radiological disc heights and trunk flexibility in patients with mechanical low back pain

Lumbosakral omurganın rutin lateral grafilerinde saptanan intervertebral disk mesafesindeki daralmaların lumbal bölgedeki biyomekanik özellikleri değiştirdiği düşüncesinden yola çıkılarak planlanan çalışmada, mekanik bel ağrılı hastalar ve kontrol bireylerde, L4-L5 ve L5-S1 disk yükseklikleri, rutin lateral radyografilerde değişik metodlar kullanılarak ölçülmüş ve bu bulgularla bireylerin fron¬tal ve sagital plandaki bel hareketleri arasındaki ilişkiler araştırılmıştır. Yaşlan 28 ila 54 arasında değişen (ort:38,l±10.7) ve klinik inceleme sonucunda mekanik bel ağrısı tanısı alan 25 hasta ve aynı yaş grubunda 20 kontrol bireyde bel bölgesinin öne fleksiyon açıklığı modifiye Schober fleksiyon testi ile, sağ ve sol lateral fleksiyon açıklıkları ise modifiye Moll lateral fleksiyon testi ile ölçüldü. Radyografilerde disk mesafesi ölçümleri Hurxthal 2 metodu, Rl ve R2 metodu, Farfan metodu ve Dabbs metodu ile belirlendi. Bel ağrısı olan hastaların modifiye Schober ve modifiye Moll ölçümleri kontrol bireylere göre anlamlı düzeyde azalmış bulundu. Ağrılı grupta vücut kitle indeksi ortalamaları fazla bulunurken, iki grup arasında disk mesafelerinin tüm metodlarla ölçümleri açısından bir fark saptanmadı. Radyolojik ölçümlerde kullanılan tüm metodların birbirleri ile uyumlu oldukları gözlendi. L5-S1 disk mesafesi ölçüm sonuçları ile modifiye Schober fleksiyon ölçümleri arasında ve L4-L5 mesafesi ile modifiye Moll lateral fleksiyon değerleri arasında istatistiksel olarak anlamlı bir ilişkinin varlığı saptandı. Sonuç olarak, her nekadar radyolojik ve klinik bulgular arasında zayıf bir ilişkiden söz ediliyorsa da, idiopatik bel ağrısında disk mesafelerinin bel mobilitesi ile ilişkili olabileceği sonucuna varıldı.Although radiographic disc space narrowing is often poorly correlated with clinical findings in patients with low back pain, changes in disc heights are suspected to alter the biomechanics of the lumbar spine. The aim of this study was to describe and obtain different measurements of the L4-L5 and L5-S1 disc heights on the lateral radiographs of low back pain patients and control cases and to investigate the correlation between the radiographic findings and trunk flexibility measurements in the study group. 25 patients between 28 and 54 years of age (mean 38.1±J0.7), who were diagnosed to have mechanical low back pain and 20 control subjects of the same age group were included in the study. The trunk flexibility was measured by using the modified Schober flexion test for forward flexion, and modified Moll lateral flexion test for right and left lateral flexion. Disc space measurements were made on the radiographs by using the Hurxhall method 2, Rl and R2 methods Farfan method and Dabbs method. Statistically significant decrease in modified Schober and modified Moll measurements and significant increase in body mass index were found in the low back pain group. No statistical difference was determined between the disc height measurements of two groups. All of the measurements made by using different methods were correlated with each other. The L5-S1 disc space was found to be correlated with the modified Schober flexion measurements andL4-L5 disc space was found to be correlated with the modified Moll lateral flexion measurements in the study group. The results indicated a possible relation between disc heights and trunk flexibility in patients with mechanical low back pain

Clinical and laboratory features of patients with musculoskeletal brucellosis

Amaç: Kırıkkale ve kırsalında kas-iskelet sistemi tutulumu olan brusellozisli hastalarda demografik, klinik ve laboratuvar özellikleri incelemek. Gereç ve Yöntemler: Çalışmaya kas-iskelet sistemi tutulumu olan brusellozis tanısı konulmuş 28 hasta dahil edildi. Hastaların demografik özellikleri, yakınmasının süresi, şekli, olası enfeksiyon kaynağı sorgulandı. Ayrıntılı sistemik ve kas-iskelet sistemi muayene bulguları not edildi. Rutin biyokimya, tam kan sayımı, eritrosit sedimentasyon hızı, C-reaktif protein, romatoid faktör, antinükleer antikor, kan kültürü ve standart tüp aglütinasyon testleri yapıldı. Hastaların tümünde sakroiliak, lumbosakral ve gerekli görülen durumlarda periferik eklem radyografileri değerlendirildi. Klinik ve radyografik olarak derin eklemlerin tutulumundan şüphede kalındığı durumlarda magnetik rezonans görüntüleme yönteminden faydalanıldı. Bulgular: Hastaların yaş ortalaması 39.4 ± 14.4 yıl, hastalık süreleri 10.1 ± 12.7 aydı ve %64.3’ü erkekti. En sık izlenen semptom artralji (%85.7), bulgu ise splenomegaliydi (%32.1). Kan kültürü %39.3 hastada pozitifti. Eklem tutulumu olarak periferik artrit %71 oranı ile ilk sıradaydı ve en sık tutulan periferik eklemler %35 ile kalça ve dizdi. Sakroiliit %32 hastada tespit edildi ve %89’u unilateraldi. Spondilit %14 hastada ve en sık lomber segmentte (%75) izlendi. Her bir kas-iskelet sistemi tutulumunun tipi tüm parametreler açısından diğerleri ile kıyaslandığında sakroiliit grubunda sadece sakroiliak testleri pozitifliği, spondiliti olan grupta yaş, perküsyonla vertebra hassasiyeti ve spinal hareketlerle ağrının varlığı, diğerlerinden anlamlı düzeyde farklıydı (p< 0.05). Sonuç: Bölgemizde brusellozis saptanan ve aynı zamanda kas-iskelet sistemi tutulumu olan olgularda en sık tutulum periferik eklemlerde izlenmektedir. Sakroiliak ekleme yönelik özel testler sakroiliit için yol gösterici olabilir. Özellikle spinal hareketleri ağrılı ve perküsyonla hassasiyet saptanan brusellozisli yaşlı hastalarda omurga tutulumu olabileceği akılda tutulmalıdır. Spinal ya da periferik eklem ağrısı olan ve yumuşak doku romatizmasına bağlı şikayeti bulunan hastalarda brusellozis ayırıcı tanıda yer almalıdır.Objective: To evaluate the demographic, clinical and laboratory features of patients with musculoskeletal brucellosis in urban and rural areas of Kırıkkale, Turkey. Material and Methods: Twenty-eight patients with the diagnosis of musculoskeletal brucellosis were included in the study. All patients were questioned for demographic characteristics, duration and characteristics of complaints and possible source of infection. The findings of detailed systemic and musculoskeletal examinations were noted. Routine blood chemistries, complete blood count, erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, antinuclear antibody, blood culture and standard tube agglutination tests were carried out. Radiographs of the sacroiliac joints and lumbosacral spine of all patients and, if required, radiographs of peripheral joints were evaluated. Magnetic resonance imaging was performed on those in whom deep joint involvement was suspected clinically and radiographically. Results: Patient mean age was 39.4&plusmn;14.4 yr, mean duration of disease was 10.1 &plusmn; 12.7 yr, and 64.3% of the patients were male. The most frequent symptom was arthralgia (85.7%), and the most prevalent sign was splenomegaly (32.1%). Blood cultures were positive in 39.3% of the patients. Peripheral arthritis had the highest incidence with a rate of 71% in joint manifestations, and the most frequent involvement sites were hip and knee with a ratio of 35%. Sacroiliitis was detected in 32% and was unilateral in 89% of the patients. Spondylitis was found in 14% of the patients, most frequently in lumbar segments (75%). Each musculoskeletal involvement site in terms of all parameters were compared with the others and only the sacroiliac test in the sacroiliitis group and age, vertebral tenderness with percussion and the presence of painful spinal movements in spondylitis group were significantly different from the others (p&lt; 0.05). Conclusion: Peripheral joints are the most common articular involvement sites in patients with musculoskeletal brucellosis in our region. Specific sacroiliac joints tests may serve as guides to sacroiliitis. Spinal involvement should be kept in mind in elderly patients with brucellosis, particularly when spinal movements are painful or tenderness is elicited with percussion over the spine. Brucellosis should be included in the differential diagnosis of patients with spinal or peripheral joint pain and in those presenting with complaints due to soft tissue rheumatism

Evaluation of intraabdominal hypertension and genitofemoral nerve motor conduction

Background/aim: The aim of this study was to electrophysiologically evaluate the effect of increased intraabdominal pressure (IAP) on genitofemoral nerve (GFN) motor conduction. Materials and methods: Seven Wistar albino rats were included. After anesthetization, latency and duration of GFN conduction was recorded with a needle-probe at rest. IAP was increased to 15 mmHg by insufflating atmospheric air with a percutaneous intraperitoneal needle. At 30 min of IAP, GFN motor conduction was recorded. Abdominal pressure was then increased to 20 mmHg. At 60 min, GFN motor conduction was recorded again. The consecutive recordings of latency and duration of GFN conduction (rest, 30 min, 60 min) were evaluated statistically. Results: There was a significant difference between latencies at rest (1.90 &plusmn; 0.22 ms), at 30 min (2.3 &plusmn; 0.36 ms), and at 60 min (2.74 &plusmn; 0.57 ms) (Friedman test, P = 0.001). The latency was significantly increased at 60 min compared to rest (post hoc Tukey test, P = 0.003). No similar difference was detected between the recordings at 30 and 60 min. The duration of GFN motor conduction showed no difference between consecutive recordings (P = 0.067). Conclusion: Both increased and prolonged IAP causes prolonged latency of GFN conduction, probably due to a compression effect on GFN. Neuropraxial consequences of increased IAP are thought to be related to the compression effect of peripheral nerves

Çocukluk Çağında Lipoma Arboresan: İki Kız Kardeşin Sunumu

Lipoma arboresan (LA) sinovyal eklemler ve bursaların nadir benign bir lezyonudur. En sık tutulum yeri dizlerdir. Manyetik rezonans görüntüleme bulguları tipiktir. Çocuklardaki LA olgu sunumlarının sayısı, erişkinlere kıyasla oldukça azdır. Bu çalışmada, her iki dizde ağrı ve şişlik yakınması muayene edilen dokuz ve 15 yaşlarındaki iki kız kardeş sunuldu. Manyetik rezonans görüntülemede her iki çocuğun sağ dizinde LA için tipik özellikler gösterildi. Çocukluk çağındaki hastalarda sistemik tutulum olmadan mono/oligoartiküler efüzyon ve sinovyal hipertrofi varlığında, ayırıcı tanıda LA akla getirilmelidir. Manyetik rezonans görüntüleme, LA tanısında duyarlı bir yöntemdirLipoma arborescens (LA) is a rare benign lesion of synovial joints and bursae. The knee is the most common site of the involvement. Magnetic resonance imaging findings are typical in the diagnosis. The number of case reports of LA in children is significantly lower compared to the adults. In this article, two nine-year-old and 15-year-old sisters who were examined for the complaints of bilateral pain and swelling in knees were presented. Magnetic resonance imaging demonstrated typical features of LA in the right knees of both children. Pediatric patients with mono/oligoarticular effusion and synovial hypertrophy without systemic involvement, LA should be considered in differential diagnosis. Magnetic resonance imaging is a sensitive modality in the diagnosis of LA

Consensus report for workshop on ⇜early diagnosis and intervention in cerebral Palsy” Turkey’s approach to babies at risk and suggestions 1. National congress on babies at risk (1-4 March 2018, the Ankara Hotel)

The workshop on “Early Diagnosis and Intervention in Cerebral Palsy” aimed to reflect the current situation of and the challenges encountered in the early diagnosis and intervention in cerebral palsy in babies at risk, in order to raise awareness in the corresponding community by putting forth suggestions for providing solutions to these problems, and also, to provide a model suggestion suitable for the whole country. In the direction of these purposes, problems encountered in the prenatal, natal, and postnatal periods, and the corresponding suggestions were discussed, and vital topics concerning numerous disciplines, especially for the postnatal period, were emphasized in the workshop. With the aim of providing a solution to the current problems in the country regarding the matter, by employing an interdisciplinary approach, the establishment of Monitoring Centers for the Babies at Risk was proposed, and a model for these centers was created. Implications derived from this workshop will establish a foundation for the creation of a special strategic plan for the early diagnosis and intervention in cerebral palsy for the babies at risk. Copyright © 2018 by Türkiye Klinikleri

Musculoskeletal ultrasound publications in rehabilitation journals: A EURO-MUSCULUS/USPRM update

Background: The utility of musculoskeletal ultrasound (US), both in the clinical settings and scientific arena, has significantly increased in recent years. Aims: The aim of this study was to report and analyze the publications on musculoskeletal US in top rehabilitation journals (indexed by the ‘Rehabilitation’ category of Journal Citation Reports (JCR), Clarivate Analytics). Methods: The search was carried out up to July 2018 through Web of Science (Science Citation Index-Expanded). The literature search comprised all 65 journals listed in the 2017 category “Rehabilitation” according to the JCR. Results: A total of 971 papers published in 39 different journals from 1989 to 2018 were analyzed. The top three publishing countries (in decreasing order) appeared as the United States of America (USA), Turkey and Taiwan. The American Journal of Physical Medicine and Rehabilitation, PM&amp;R and the Archives of Physical Medicine and Rehabilitation were the top three journals (in decreasing order) publishing about topics on musculoskeletal US. The most commonly studied diseases in humans were musculoskeletal conditions, followed by neurological disorders. Physiatrists and PRM departments (46.9%) prevail as far as publishing specialties were concerned. Although the use of interventional US seems to have increased after 2000, diagnostic US is still ranked the first, when the purpose of the conducted study is taken into consideration. Conclusion: Accordingly, we believe that this scientific output might help to raise awareness as regards the potential role of US in Physical and Rehabilitation Medicin

Threats and conservation of landscapes in Turkey.

International audienc