Effects of isotonic and isometric hand exercises on pain, hand functions, dexterity and quality of life in women with rheumatoid arthritis

The primary objective of our study was to evaluate the effect of 6-week-long isotonic and isometric hand exercises on pain, hand functions, dexterity and quality of life in women diagnosed as rheumatoid arthritis (RA). Our secondary objective was to assess the changes in handgrip strength and disease activity. This randomized, parallel, single-blinded 6-week intervention study enrolled 52 female patients between 40 and 70 years of age, who were diagnosed with RA according to American College of Rheumatology criteria, had disease duration of at least 1 year and had a stage 1–3 disease according to Steinbrocker’s functional evaluation scale. Patients were randomized into isotonics and isometrics groups. Exercises were performed on sixth week. All patients were applied wax therapy in the first 2 weeks. Their pain was assessed with visual analog scale (VAS), their hand functions with Duruöz Hand Index (DHI), dexterity with nine hole peg test (NHPT) and quality of life with Rheumatoid Arthritis Quality of Life questionnaire (RAQoL). Dominant and non-dominant handgrip strengths (HS) were measured. Disease activity was determined by disease activity score (DAS 28). We evaluated the difference in the above parameters between baseline and 6 weeks by Wilcoxon paired t test. The study was completed with 47 patients (isotonics n = 23; isometrics n = 24). VAS, DHI, NHPT, and RAQoL scores significantly improved in both groups by the end of 6th week compared to the baseline scores of the study (for isotonics p = 0.036, p = 0.002; p = 0.0001, p = 0.003; for isometrics p = 0.021, p = 0.002, p = 0.005, p = 0.01, respectively). DAS 28 scores decreased in both exercise groups (p = 0.002; p = 0.0001, respectively), while isometrics showed a significant increase in dominant HS (p = 0.029), and isotonics showed a significant increase in non-dominant HS (p = 0.013). This study showed that isometric and isotonic hand exercises decrease pain and disease activity and improve hand functions, dexterity and quality of life as well as mildly increasing muscle strength in patients diagnosed as RA.     

Predictors for quality of life in continuous ambulatory peritoneal dialysis patients

Aim: Peritoneal dialysis patients have diminished quality of life scores compared with healthy subjects. Measures of quality of life have been reported to have a significant predictive value for patient survival and hospitalization in peritoneal dialysis patients. The purpose of this study is to determine the clinical, biochemical and psychological predictors for the quality of life in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods: This cross-sectional study included 60 CAPD patients (male/female 33/27; age 45.5 ± 15.7 years, CAPD duration 43.4 ± 32.7 months). Pittsburg Sleep Quality Index was used for assessing sleep quality. We evaluated each patient's depressive symptoms with Beck Depression Inventory (BDI). Quality of life parameters were assessed by the self-administered SF-36 generic health survey questionnaire. In all patients, demographic variables, personality traits and habits, Charlson Comorbidity Index, clinical and laboratory parameters were recorded and analysed. Results: A Pearson bivariate correlation analysis revealed that total quality of life score was negatively correlated with Pittsburg Sleep Quality Index (–0.533, P < 0.0001), BDI (−0.642, P < 0.0001) scores, C-reactive protein (−0.588, P = 0.001), and positively correlated with blood urea nitrogen (0.336, P = 0.02) and albumin (0.351, P = 0.01). BDI scores (β = −0.505, P = 0.001) and the serum albumin levels (β = 0.324, P = 0.009) were the significant independent predictors of quality of life. Conclusion: Poor sleep quality, presence of depression, higher C-reactive protein and lower albumin levels are associated with poorer quality of life. In order to improve life quality in CAPD patients, quality of sleep, depression and nutritional status should be serially evaluated and given appropriate treatment when required.     

Mortality risk factors in chronic renal failure patients after coronary artery bypass grafting

Perioperative risk during coronary artery bypass grafting (CABG) is high in patients with chronic renal disease. We aimed to determine postoperative two-year mortality and identify the preoperative risk factors of mortality during CABG surgery in hemodialysis (HD)-dependent and HD-non-dependent CRF patients. We included 102 CRF patients who underwent CABG in Baskent University Hospital between 2000 and 2005. There were 47 patients with CRF undergoing HD (Group I) and 55 CRF patients without dialysis requirement (Group II). We retrospectively retrieved demographic variables; clinical, operative, and echocardiographic data; and biochemical parameters at the time of the operation and six months postoperation. Postoperative HD requirement in Group II patients and infectious complications were recorded. In the second postoperative year, mortality rate was 27.7% in group I and 16.4% in group II (p > .05). When preoperative risk factors evaluated by univariate Cox analysis, only age (RR = 1.06, p = .04) was a significant determinant of survival in Group I patients. Among the operative and postoperative risk factors of mortality such as duration of operation, numbers of coronary vessel bypass, HD requirement, and infection were investigated in Group I and II patients. Rate of infectious complication (including mediastinitis) was found to be a major determinant of mortality by multivariate Cox analyses in both group I (RR = 4.42, p 相似文献   

Comparison of GnRH agonists and antagonists in normoresponder IVF/ICSI in Turkish female patients

Purpose To evaluate the results of gonadotropin-releasing hormone agonist (GnRHa) and gonadotropin-releasing hormone antagonist (GnRHant) use in two demographically matched groups of normoresponder in-vitro fertilisation or intracytoplasmic sperm injection (IVF/ICSI) patients in a prospective study. Methods We randomised 93 patients undergoing IVF/ICSI between May 2005 and August 2006. Patients with IVF indications were included except for those with polycystic ovary syndrome or azoospermia, women older than 38 years and those with follicle-stimulating hormone (FSH) ≥10 IU/ml. Patients were stimulated with standard 225 IU recombinant FSH. In Group I (n=45) a daily dose of GnRHant cetrorelix acetate 0.25 mg was administered when follicles reached a diameter of ≥14 mm. Group II (n=48) patients were desensitised with the GnRHa, leuprolide acetate, in a long protocol. Human chorionic gonadotropin (hCG) was administered when at least three follicles of 18 mm in diameter were observed. Oocyte retrieval was scheduled 36 hours following hCG administration and embryos were transferred on day 3 after oocyte retrieval. Results The two groups were homogenous for age, infertility duration, basal FSH and serum oestradiol (E2) (P=0.537, P=0.911, P=0.103 and P=0.733, respectively). In Group II (the GnRHa group) more antral follicles (P<0.001), a longer induction duration (P=0.017) and higher peak E2 levels (P<0.001) were observed. No differences were observed in the number of oocytes retrieved (P=0.749), embryos achieved and transferred (P=0.677), or fertilisation rates (P=0.839) between the two groups. There was no statistically significant difference between groups in clinical pregnancy rates, cycle cancellation and ovarian hyperstimulation (P=0.437, P=0.109 and P=0.415, respectively). Conclusion GnRHant and GnRHa provide comparable results in normoresponder patients, while GnRHant allows a greater flexibility in their treatment.     

The effect of levonorgestrel-releasing intrauterine device on menorrhagia in women taking anticoagulant medication after cardiac valve replacement

Background

This study was conducted to evaluate the effect of levonorgestrel-releasing intrauterine devices (LNG-IUDs) on menorrhagia in patients receiving anticoagulant therapy after cardiac valve replacement.

Study Design

Forty women with menorrhagia who underwent cardiac valve replacement and were taking anticoagulant medication were enrolled in the study. The women were randomly divided into two groups: LNG-IUDs were inserted into 20 women in Group 1 over the first 3 days of menstrual bleeding, while the women in Group 2 were followed without any intervention. The activated partial thromboplastin time, prothrombin time, international normalized ratio, hematocrit level, hemoglobin level, ferritin level and pictorial bleeding assessments for the quantity of menstrual bleeding were recorded.

Results

Three months after insertion of LNG-IUDs, the women in Group 1 had a significant decrease in blood loss and higher hemoglobin, hematocrit and ferritin values. No difference was detected for these parameters in the control group at the third and sixth months of the study. Coagulation parameters did not differ between the two groups.

Conclusion

LNG-IUDs can be considered as an effective non-surgical treatment for menorrhagia in women receiving anticoagulant therapy after cardiac valve replacement.     

Cardiac and pulmonary investigations in Bethlem myopathy

BACKGROUND: Bethlem myopathy is considered a relatively mild neuromuscular disorder without significant cardiac and respiratory involvement. OBJECTIVE: To investigate cardiac and respiratory involvement in Bethlem myopathy. DESIGN: Cross-sectional study. SETTING: University hospitals. Patients Fifty patients with Bethlem myopathy from 26 families. INTERVENTIONS: Cardiac examinations, including electrocardiography and echocardiography (n = 37) and pulmonary investigations (n = 43). Holter monitoring was performed in 16 patients. MAIN OUTCOME MEASURES: Cardiac and respiratory abnormalities. RESULTS: Several cardiac abnormalities were found that were considered unrelated to the muscular disorder. Seven (16%) of 43 patients had a forced vital capacity less than 70% of the predicted value. One of 2 patients with a forced vital capacity less than 50% was also receiving respiratory support. All patients with compromised respiratory function were still ambulatory, and we found no significant correlation between the severity of arm weakness and the severity of respiratory muscle involvement. CONCLUSIONS: There is no evidence of cardiac involvement in Bethlem myopathy. Respiratory failure is part of the clinical spectrum and can occur in ambulatory patients.     

Application of the new classification criteria of the Acute Kidney Injury Network: a pilot study in a pediatric population

The purpose of our study was to apply the new classification criteria proposed by the Acute Kidney Injury Network (AKIN) in a pediatric population and to determine the clinical characteristics, laboratory features and outcomes of acute kidney injury (AKI) in a tertiary pediatric nephrology center in Turkey. Patients’ charts from January 2003 to August 2008 were retrospectively evaluated. One hundred patients (55 male; 45 female) were enrolled. Median age at the time of AKI was 7 years (range 1 month−18 years). Patients’ AKI was classified according to the staging system as follows: 25% stage 1, 36% stage 2 and 39% stage 3. The etiology of AKI was bone marrow transplantation related in 27%, renal disease in 14%, dehydration in 10%, nephrotoxic medication in 8%, cardiac surgery related in 8%, and congenital anomalies in 2%. Multiple etiologic factors with underlying chronic diseases were present in 31% of the patients. Dialysis was needed in 45% of the patients. Mortality rate was 33%. Dialysis need and mortality rate were higher in stage 2 and stage 3 patients, with a more favorable prognosis in stage 1 patients. Mortality rate was higher in patients that had undergone cardiac surgery and in those with multiple etiologic factors. The proposed AKIN staging successfully reflected the course of patients with AKI. The underlying cause of AKI seemed to be an important risk factor for death.     

Multiple jejunoileal perforations because of intestinal involvement of miliary tuberculosis in an infant

Infants are more susceptible to tuberculous bacilli and may develop severe extrapulmonary and miliary forms of the disease. However, miliary tuberculosis (MT) presenting with multiple intestinal perforations as an initial manifestation of the disease is extremely rare in children. The authors describe an infant who underwent emergency laparotomy because of jejunoileal perforations secondary to intestinal involvement of MT to emphasize the characteristics of the abdominal disease and the importance of controlling systemic disease to achieve a favorable outcome.