Ali İzZet Akçin

Objective: We aimed to evaluate the effectiveness of combining low-frequency (1 Hz) rTMS (LF-rTMS) over the unaffected hemisphere or intermittent theta burst stimulation (iTBS) over the affected hemisphere with conventional rehabilitation (CR) on lower extremity motor function, balance, and gait. Design: This single-center, randomized, sham-controlled study included patients with chronic stroke (>6 mo) and unilateral hemiplegia (Brunnstrom stages 3 to 5), who were assigned to LF-rTMS+CR (n=21), iTBS+CR (n=21), or sham rTMS+CR (n=21) for 10 sessions using a figure-of-eight coil. All active participants completed treatment, and 18 sham participants were analyzed. The Fugl-Meyer Assessment, Berg Balance Scale (BBS), Timed-Up and Go (TUG) test, Functional Independence Measure, and 36-item Short-Form Health Survey (SF-36) were performed during pretreatment, post-treatment, and 6-week follow-up, alongside assessments of the Hmax/Mmax amplitude at baseline and 6-week follow-up. Results: Both real rTMS groups showed greater improvements in balance and mobility (BBS and TUG) versus sham group. In addition, intragroup evaluation revealed that improvements in mental function and general health (SF-36) were more pronounced in the real rTMS groups. Conclusions: The combination of rTMS, including LF-rTMS or iTBS, with CR may serve as an effective neurorehabilitation strategy to improve balance and mobility in individuals with chronic stroke.

Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy, with inflammation suggested as a possible contributing factor in its pathogenesis. This study aimed to investigate the relationship between the severity of CTS and inflammatory blood markers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV). A total of 246 participants were included, comprising 150 patients diagnosed with CTS based on clinical and electrophysiological findings, and 96 healthy controls. Patients were classified as having mild, moderate, or severe CTS according to Padua's electrophysiological criteria. Complete blood counts were obtained after fasting, platelet parameters, NLR and PLR were calculated. Statistical analyses were conducted to compare hematological parameters between CTS patients and controls, and among CTS severity subgroups. No significant differences were found between CTS patients and controls in terms of neutrophil, lymphocyte, platelet counts, NLR, PLR, MPV, or PDW values (p>0.05). Similarly, subgroup analyses revealed no significant variation in these parameters across CTS severity levels. Correlation analysis showed a weak negative correlation between CTS severity and neutrophil count (r=-0.232, p=0.004), and NLR (r=-0.199, p=0.015). NLR was positively correlated with neutrophil count and PLR, and negatively with lymphocyte count. The findings suggest that NLR, PLR, and MPV may not be reliable markers of systemic inflammation in CTS population or its severity. Local inflammation may not always reflect systemic inflammatory status, and non-inflammatory mechanisms such as fibrosis might also play a role in CTS pathogenesis.

Falls are a major concern for hemiplegic stroke patients, often leading to serious injuries and reduced quality of life. Identifying at-risk individuals is crucial for effective prevention. This study assesses fall risk prevalence and associated factors in hemiplegic patients using the Falls Risk for Older People in the Community (FROP-Com) and determines stroke-specific cutoff values. Additionally, it examines its relationship with the Timed Up and Go (TUG) test and Tinetti Performance-Oriented Mobility Assessment (POMA). This cross-sectional study included hemiplegic stroke patients. Fall risk was assessed using the FROP-Com, while mobility was evaluated with the Tinetti POMA and TUG test. Clinical characteristics such as age, stroke duration, functional mobility, and fall history were recorded. Correlations between assessment tools were analyzed, and a cutoff value for high fall risk was established. Sixty patients were analyzed (mean age 59.28±7.02 years; 66.7% male; 72% ischemic stroke). Falls were reported in 41.7% of patients, with 48% sustaining injuries. Most falls occurred indoors (56%), with balance loss being the primary cause (52%). Patients with a history of falls had significantly lower POMA scores and higher FROP-Com and TUG scores (p<0.05). The FROP-Com fall risk cutoff was 21 (AUC=0.78, sensitivity=68%, specificity=85.7%). The FROP-Com is a valuable tool for assessing fall risk in hemiplegic stroke patients, aiding in the identification of high-risk individuals and supporting targeted prevention strategies.

Brucella is a gram‐negative zoonotic agent transmitted by consumption of raw milk and infected meat. Among musculoskeletal manifestations, axial involvement such as spondylodiscitis and sacroiliitis is well documented, while peripheral manifestations like tenosynovitis and rice bodies remain underreported. In this case, flexor tenosynovitis and associated rice body involvement due to Brucella, which developed progressive swelling, pain, and restricted movement in the wrist and third finger of the hand after a minor abrasion, were investigated ultrasonographically. As far as we know, this is the first reported case of primary brucellosis with flexor tenosynovitis and associated rice bodies demonstrated ultrasonographically in the literature.

Objective: Ideal volume of 5% dextrose for median nerve hydrodissection for treating carpal tunnel syndrome is still unknown. This study assessed the efficacy of nerve hydrodissection using varying volumes of 5% dextrose for treating mild to moderate carpal tunnel syndrome. Design: Eighty participants with unilateral mild to moderate carpal tunnel syndrome were randomized into groups to receive either 5 ml of normal saline, 5 ml of 5% dextrose, 10 ml of normal saline, and 10 ml of 5% dextrose, with each group undergoing one session of ultrasound-guided hydrodissection. Visual analog scale, Boston Carpal Tunnel Syndrome Questionnaire, grip and pinch strength, cross-sectional area of median nerve, and electrophysiological assessment were performed at baseline and weeks 4 and 12. Results: In the 10 ml 5% dextrose group, visual analog scale scores considerably improved compared with those in the normal saline groups. Although nerve cross-sectional area values decreased in all groups during follow-ups, the 10 ml 5% dextrose group showed a statistically significant improvement compared to the normal saline groups by the 12th week (P ≤ 0.01). Conclusions: Ultrasound-guided median nerve hydrodissection with 10 ml 5% dextrose was more effective in reducing pain and nerve size than the normal saline groups at the 12th week.

Aims: Neurofibromatosis type 1 (NF-1) is a relatively rare disorder with autosomal dominant inheritance. Despite current reports highlighting the association between NF-1 and some rheumatic diseases (e.g., systemic lupus erythematosus, juvenile idiopathic arthritis, ankylosing spondylitis, and antiphospholipid antibody syndrome), the literature seems to have missed focusing on its relationship with rheumatological disorders. Hence, the present study attempted to explore definite NF-1 molecular genetic mutation in association with accompanying rheumatic diseases, particularly rheumatoid arthritis. Methods: The patients (n=23) aged 18 years who were diagnosed with NF-1 genetic mutation between 2010-2022 in the medical genetics department of our university were recruited for medical examination regarding rheumatic disorders in our rheumatology outpatient clinic. Results: There were a total of 23 patients in this study, 14 (60.9%) males and 9 (39.1%) females, with a mean age of 27.4±9.2 years (18-51 years). As a result, 4 (17.3%) patients were diagnosed with rheumatoid arthritis (RA), 3 with seropositive RA, and one with seronegative RA. Of the diagnoses, two were established RA, and two were early RA. All patients with RA had a positive metacarpophalangeal joint (MCP) squeeze test and experienced pain in bilateral hands and wrists and morning stiffness for more than 45 min. Conclusion: While the community prevalence of RA is about 1%, it is noteworthy that we detected RA in 17.3% of our patients. In the follow-up of patients with NF-1, routine examinations for pain in bilateral hands and wrists, morning stiffness over 45 minutes, and positivity of the MCP squeeze test are thought to allow early diagnosis of RA and, thus, relevant therapies.

Objectives: We evaluated pain, fatigue, anxiety, depression, and quality of life in patients hospitalized for coronavirus disease 2019 (COVID-19) and observed them over a period of 3 months. We also investigated the relationship of these symptoms to age, gender, disease severity, and levels of anxiety and depression.Methods: The study included 100 confirmed COVID-19 patients (i.e., positive on a polymerase chain reaction test) between the ages of 18 and 75 years. Pain (visual analog scale [VAS]), fatigue (fatigue severity scale), anxiety, and depression (hospital anxiety and depression scales) were evaluated on the first day of hospitalization and at 1-month and 3-month follow-ups. The short form-12 questionnaire was used to measure quality of life at the 1-month and 3-month follow-ups.Results: No differences were found in pain, fatigue, anxiety levels, depression levels, and quality of life according to disease severity. High VAS scores at hospital admission were related to continued pain at the 3-month follow-up (odds ratio [OR], 1.067; p<0.001). High VAS (OR, 1.072; p=0.003) and anxiety levels (OR, 1.360; p<0.007) were related to severe fatigue at the 3-month evaluation.Conclusion: Pain, fatigue, anxiety, and depression appear to be long-term sequelae of COVID-19 and can affect quality of life. High VAS and anxiety levels were found to be associated with long-term fatigue.