Trunk muscle strength in relation to balance and functional disability in unihemispheric stroke patients

OBJECTIVE: To evaluate trunk muscle strength in unihemispheric stroke patients and to assess how it relates to body balance and functional disability in this patient group. DESIGN: This prospective case-comparison study investigated isometric and isokinetic reciprocal trunk flexion and extension strength at angular velocities in 38 unihemispheric stroke patients and 40 healthy volunteers. The Berg balance scale was used to assess balance and stability, and the FIM instrument was used to evaluate functional disability in the patient group. Patients were evaluated as soon as they were able to stand long enough for testing. RESULTS: Peak torque values for trunk flexion and extension were lower in the stroke patients than in the controls. The differences were significant for trunk flexion and for trunk extension. In both groups, peak torque values for trunk flexors were greater than peak torque values for trunk extensors. There was a significant positive correlation between trunk muscle strength and Berg balance scale score at discharge. Trunk muscle strength was not correlated with FIM total score or FIM motor score, but the locomotion-transfers FIM subscore at discharge was positively correlated with trunk muscle torque values, except for isometric extension. CONCLUSION: The findings indicate trunk flexion and extension muscle weakness in unihemispheric stroke patients, which can interfere with balance, stability, and functional disability.     

Assessment of left ventricular diastolic function with Doppler tissue imaging: effects of preload and place of measurements

Mitral inflow velocities are widely used for the evaluation of left ventricular (LV) diastolic function. However, they are closely affected by other factors such as preload. The purpose of this study was to evaluate the usefulness of tissue Doppler velocities obtained from the mitral annulus for the evaluation of ventricular relaxation in patients under different loading conditions. We also evaluated the effect of preload at different sides on the mitral annulus. The study population consisted of 62 consecutive patients (38 male, 24 female with a mean age of 42 ± 13 years) who have undergone hemodialysis. Both mitral inflow velocities (E wave, A wave, E wave deceleration time and isovolumetric relaxation time) and mitral annulus tissue Doppler velocities (E, A) from the septal, lateral, anterior, posterolateral and inferior sides of the mitral annulus were measured immediately before and after hemodialysis. Mitral inflow E and A wave velocities and E/A ratio decreased significantly (p < 0.001, p = 0.007, p < 0.001, respectively) after hemodialysis. Mitral annulus E wave velocities and E/A ratios obtained from five different sides of the annulus also changed significantly (p < 0.001 for all); however, there was no change in the A wave velocity (p > 0.05 for all) after hemodialysis. The decrease in E wave and E/A ratio in mitral inflow measurements and E velocities and E/A ratios in tissue Doppler measurements were correlated with the amount of fluid extracted (for mitral inflow E wave, r = 0.392, p = 0.002 and E/A ratio, r = 0.280 and p = 0.027; for lateral side E, r = 0.329, p = 0.009 and E/A ratio, r = 0.286, p = 0.04; for septal side E, r = 0.376, p = 0.003 and E/A ratio, r = 0.297, p = 0.019; for anterior side E, r = 0.342, p = 0.007 and E/A ratio, r = 0.268, p = 0.035; for posterolateral side E, r = 0.423, p = 0.001 and E/A ratio, r = 0.343, p = 0.007; and for inferior side E, r = 0.326, p = 0.01 and E/A ratio, r = 0.278, p = 0.029). We conclude that mitral annular velocities obtained by tissue Doppler are preload dependent parameters for the evaluation of LV diastolic function.     

The Effect of Psychological Support for the Relatives of Intensive Care Unit Patients on Cadaveric Organ Donation Rate

We searched to see whether psychological support for relatives of intensive care unit patients helps them to donate organs of their brain-dead relatives. After receiving ethics committee permission, first-degree relatives of 200 general intensive care unit patients were enrolled in the study. The participants were divided into 2 groups randomly: an interview group (n = 100) and a control group (n = 100). Participants were asked to complete a questionnaire. Interviews with the psychologist and patients' relatives in the interview group were therapeutic in nature and were conducted according to the relatives' psychosocial needs in an unstructured format. In the control group, the psychologist and patients' relatives were not interviewed. The study utilized demographic data, the questionnaire for relatives of patients to mention their attitude on organ donation and the reasons for this choice, and the Participant Information Form to record demographic data and relatives' degree of relationship with the patient. There was no statistically significant difference between the 2 groups when compared according to sex ratio, patient age, and duration of patients' hospital stay. Whereas in the interview group, 75% agreed to allow their relatives to be organ donors, only 32% in the control group agreed (P < .0001). Of the 200 patients enrolled in the study, 93 lost their lives: 50 from the interview group and 43 from the control group. Among the relatives whose patients had lost their lives, 78% belonging to the interview group accepted to donate the organs of their patients, whereas in the control group 13.9% accepted (P < .0001). We hope that psychological support for the relatives of the potential brain-dead donor to cope with the psychological problems to be faced can improve the rate of organ donation.     

Moyamoya syndrome associated with sickle cell trait in a child

Moyamoya syndrome is a chronic, progressive occlussion of cerebrovascular arteries that leads to the development of characteristic collateral vessels. It is usually accompanied with sickle cell disease and other hemoglobinopathies. We report a 7-year-old boy, who admitted to our clinic with headache, diagnosed as moyamoya syndrome associated with sickle cell trait. To date, two such cases have been reported in the literature. As far as we know, this patient is the first child reported.     

Factor XI deficiency diagnosed following use of adalimumab

Adalimumab is a drug used in the treatment of refractory psoriasis. We present a case of a 55-year-old male patient who developed petechiae and purpura after the ninth dose of adalimumab therapy. The results of laboratory investigations revealed factor XI (F.XI) deficiency. It should be recognized that F XI deficiency may develop in patients using long-term adalimumab, leading to increased risk of bleeding.KEY WORDS: Adalimumab, bleeding diathesis, bleeding, factor XI deficiency, psoriasis     

Quality of Life and Psychological Well-being in Children and Adolescents with Disorders of Sex Development

Objective:The aim of this study was to assess the quality of life (QoL) and psychological well-being in child and adolescent with disorders of sex development (DSD).Methods:Sixty-two cases, aged 2-18 years, who were followed by a multidisciplinary DSD team were included. All participants and their parents were requested the complete the Pediatric Quality Of Life Inventory (PedsQL) and the Strengths and Difficulties Questionnaire. The psychiatric diagnoses of the patients were evaluated according to Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime Turkish Version.Results:There was no significant difference between the 46,XX DSD and 46,XY DSD groups for both child and parent in Total PedsQL score. In the subscale scores, the PedsQL Physical Functionality Score reported by children was significantly lower for the 46,XX DSD group than for the 46,XY DSD group (p=0.01). There was a psychiatric diagnosis in 25.8% of cases. The PedsQL School Functionality Score reported by children in the group with psychiatric diagnosis was significantly lower than the group without psychiatric diagnosis (p=0.018). In the group with psychiatric diagnosis, the PedsQL Total Score and the subscale scores (Emotional Functionality Score, Social Functionality Score, School Functionality) reported by parents were significantly lower than in parents of the group without psychiatric diagnosis.Conclusion:This study emphasized that psychiatric disorders in DSD patients negatively affect the QoL. Psychiatric support and counseling from a multidisciplinary team are very important for families affected by DSD.