Age-related changes in pressure pain threshold, grip strength and touch pressure threshold in upper extremities of older adults

BACKGROUND AND AIMS: Hand function weakens with age in both men and women, especially after the age of 65. As the number of older people increases, more older adults may have sensorimotor impairment, which affects upper extremity (UE) performance and thus independence in the activities of daily life. The purpose of this study was to detect and evaluate the impact of age on pressure pain threshold (PPT), touch/pressure threshold and grip strength in the decades after the age of 60. METHODS: The study was carried out with the participation of older adults living in the Izmir Geriatric Centre. Older adults were subdivided into three age groups and 128 subjects (47 male, 81 female) were selected systematically as one out of every three individuals in each group (group 1: 60 to 69; group 2: 70 to 79; group 3: 80 or over). Touch/pressure threshold test, pressure pain threshold (PPT) test and grip strength measurement were performed on dominant and non-dominant hands. RESULTS: It was found out that touch/pressure thresholds increased with age, but the change was not statistically significant between the three age groups. PPT and grip strength of dominant and non-dominant hands decreased from groups 1 to 3, but analysis indicated that these declines were not statistically significant. CONCLUSIONS: Despite the fact that age-related sensorimotor changes are not statistically significant, a reduction is seen in sensorimotor parameters after the age of 60.     

Pulmonary complications of Behçet's disease

Our knowledge about pulmonary complications of Beh?et's disease continues to evolve, but we need controlled trials for the management of the disease. The main goal should be to elucidate the pathogenesis and standardize the management according to the underlying pathologic process.     

Clinical challenges in the management of a prenatally diagnosed cloacal malformation

Cloacal dysgenesis sequence is a severe malformation of the primitive cloaca and is characterized by a phallus‐like structure, smooth perineum and the absence of genitourinary and anal orifices. It is usually accompanied by oligohydramnios, kidney dysplasia, and pulmonary hypoplasia. We present a case of a 29‐year‐old woman who was referred at 26 weeks of gestation due to an enlarged fetal abdominal circumference. Investigations revealed the presence of fetal ascites, intrapelvic cysts, calcified meconium, severe oligohydramnios and a 46XX karyotype. Fetal abdominal parecentesis performed on several occasions failed to reduce intra‐abdominal pressure. To our knowledge this case represents the first variation of cloacal dysgenesis sequence to contain three dysmorphic structures along with the common findings of this anomaly.     

Active pulmonary tuberculosis with vertebra and rib involvement: case report

Multifocal skeletal tuberculosis is defined as osteoarticular lesions that occur simultaneously at two or more locations and is generally associated with disseminated disease. Although involvement of bones accounts for 1 to 5% of all tuberculosis cases, multifocal involvement of the skeleton is extremely rare. We present a case of active pulmonary tuberculosis (TB) with vertebral and rib involvement and multiple hypodense lytic lesions accompanied by a paravertebral mass lesion. In the differential diagnosis, metastases, lymphoma, multiple myeloma, chordoma sarcoidosis and rare spinal infections such as brucellosis and fungal disease were considered. The diagnosis was established by surgical biopsy, taken by video-assisted thoracoscopic surgery. Especially for patients from TB-endemic areas, tuberculosis must be considered in the differential diagnosis and treatment should be started without delay.     

Comparison of efficacy of sibutramine or orlistat versus their combination in obese women

OBJECTIVE: Sibutramine and orlistat are currently used for weight loss. We aimed to investigate the effect of orlistat and sibutramine combination therapy in treatment of obese women. SUBJECTS AND DESIGN: Study population consisted of 89 obese women who had a body mass index > or = 30 kg/m2, were normotensive, and had normal glucose tolerance. All patients were placed on a diet which contained fat approximately 30% of total calorie intake and the diet was designed to cause an energy deficit of approximately 2.51-3.56 megajoule/day. At the first month of diet (baseline), all patients were randomly divided into three therapy groups: Diet + Orlistat (group 1; n = 30 patients), Diet + Sibutramine (group 2; n = 29 patients), Diet + Orlistat + Sibutramine (group 3; n = 30 patients). Body weight, body fat distribution and serum lipid levels were evaluated baseline and after six months in all subjects. RESULTS: Mean weight loss was 5.5 +/- 4.9 kg (p = 0.024) in group 1, 10.1 +/- 3.6 kg (p < 0.001) in group 2, 10.8 +/- 6.6 kg (p < 0.001) in group 3 after the six months. Weight loss was significantly greater in group 2 (p = 0.003) and group 3 (p = 0.002) when compared with group 1. Percentage of mean weight loss was 5.5 +/- 3.1% in group 1, 10.2 +/- 4.8% in group 2, 10.6 +/- 5.7% in group 3. Percentage of weight loss was higher in group 2 (p = 0.01) and group 3 (p = 0.009) when compared with group 1. Weight loss and percentage of weight loss were not different between group 2 and group 3. CONCLUSION: These three regimens had different results on weight loss in obese women. Combination drug therapy and sibutramine therapy were both more effective than orlistat therapy alone. However, no significant difference was noted between combination drug therapy and sibutramine treatment groups.     

The value of sacroiliac pain provocation tests in early active sacroiliitis

Detection of preradiographic sacroiliitis is important for early diagnosis of ankylosing spondylitis (AS) and related spondyloarthropathies. Magnetic resonance imaging (MRI) is a valuable tool for the diagnosis of sacroiliitis in the early and active stages. The aim of this study is to assess the value of pain provocation tests in detecting early active sacroiliitis. Chronic low-back pain (LBP) patients were recruited and examined by blinded assessors for pain provocation tests: compression, distraction, Gaenslen, Mennel, Patrick, thigh thrust and sacral thrust tests. Patients underwent lumbar and sacroiliac MRI. The percentage of agreement for each pain provocation tests was between 72-95%, and the inter-rater reliability was from moderate to good (kappa, 0.43-0.87). Kappa values ranged from 0.43 to 0.60 with an agreement of 80-95% for clusters of pain provocation tests. As separately evaluated, pain provocation tests did not have favorable accuracy. When evaluated in clusters (out of three and five provocation tests) four positive over five tests on the left side reached an area under the curve 0.693 (95% CI 0.489-0.897), and two positive over three tests reached an AUC 0.697 (95% CI 0.484-0.910). Sacroiliac pain provocation tests had acceptable reliability in early active sacroiliitis; however, the discriminating capacity of these tests is poor. A multi-test regimen of three or five sacroiliac pain provocation tests may improve the accuracy of these tests discriminating sacroiliitis from LBP of mechanical origin. Four out of five selected tests or any of the two out of three selected tests have the highest predictive value.     

Tissue Resonance Interaction Method (TRIMprob) has the potential to be used alongside the recognized tests in the screening protocols for prostate cancer

Abstract:   The objective of this study was to evaluate the accuracy of the magnetic induction technique with a nonlinear tunable oscillator (the Tissue Resonance Interaction Method [TRIMprob]) in the diagnosis of prostate cancer (CaP). Overall, 148 men were split into two groups (patients at risk of CaP [Group 1] and controls [Group 2]) and evaluated with the TRIMprob. Group 1 consisted of 100 patients (mean age: 63.8 ± 7.2 years) with elevated prostate-specific antigen (>4 ng/mL) levels and/or abnormal digital rectal examination. Eleven patients (Group 2a, mean age: 59.5 ± 7.3) with previously biopsy-proven CaP served as positive controls. In addition, 37 voluntary men (Group 2b, mean age: 39.8 ± 10.4) with normal prostate-specific antigen and digital rectal examination without lower urinary tract symptoms served as negative controls. Non-linear resonance was analyzed at 465 MHz and a cut-off value of 40 units was detected as the resonance value for the best threshold to distinguish benign conditions from CaP after transrectal ultrasonography-guided biopsy with a standard 10–12 core technique in Group 1. Mean resonance values (±standard deviation) with the TRIMprob examination for patients in Groups 1 and 2b were 36.72 ± 22.35 and 73.64 ± 10.06, respectively, whereas for patients in Group 2a, it was 13.73 ± 12.12 ( P  < 0.01). Sensitivity, specificity, positive and negative predictive values of the TRIMprob using the study cohort of Group 1 were found as 76%, 61.3%, 39.6% and 88.5%, respectively. Despite some technical limitations, the non-invasive TRIMprob examination may have a role in screening protocols for CaP.