Physiotherapy interventions on chest wall mobility in obstructive lung diseases: A systematic review

PURPOSE

The aim of this systematic review was to investigate the effectiveness of physiotherapy interventions on chest mobility in obstructive lung diseases.

METHODS

Searches were performed in PEDro, Pubmed and Cochrane Central Register of Controlled Trials databases without language restrictions between 2010 and 25th December 2020. Randomized controlled trials (RCTs) investigating physiotherapy interventions on chest wall mobility were included. Two independent reviewers screened studies, extracted data, and assessed methodological quality of included studies. The assessment of risk of bias was conducted using the PEDro scale for RCTs. The articles were excluded if they have less than 5 out of 10 score.

RESULTS

Five studies included had good to excellent quality. A total of 139 patients were included in all RCTs. Intervention duration ranged from a single session to 12 weeks and the intervention schedules varied, consisting of 1-24 sessions, lasting 5-45 min per sessions. Three studies used respiratory muscle stretching and releasing techniques, one study combined respiratory muscle stretching with aerobic training, and one study planned diaphragmatic breathing. Four studies assessed chest wall mobility with optoelectronic plethysmography, whereas one study used measuring tape.

CONCLUSIONS

The result of this first systematic review that investigates the effects of physiotherapy interventions on chest wall mobility in obstructive lung diseases suggests that more and better quality RCTs with objective measurement tools are required.

A multi-dimensional assessment of internet gaming disorder in children and adolescents: A case-control study

BACKGROUND

Internet gaming disorder (IGD) leads to social disturbances and isolation, neglect of daily responsibilities, behavioral disorders, and physical impairments.

OBJECTIVE

This study aimed to investigate the effect of IGD on spine biomechanics, range of motion in the neck and low back, and lung functions and respiratory muscle strength in children and adolescents.

METHODS

Sixty-four children and adolescents with IGD (Group I) and 41 healthy controls (Group II) were included in the study. The outcomes were assessed with the Visual Analogue Scale (VAS), Internet Addiction Scale, active range of motion (AROM) in the neck and lumbar spine, posture and spinal alignment, lung function tests, and respiratory muscle strength.

RESULTS

There is a significant difference in pain intensity at rest, during activity, and daily sitting time between groups (p < 0.05). Craniovertebral angle, shoulder asymmetry, thoracic kyphosis angle, cervical extension and rotation, and right lumbar rotation significantly decreased in Group I than in Group II (p < 0.05). Besides, the PEF, FEF 25-75%, and respiratory muscle strength were lower in Group I than in Group II (p < 0.05). With a multiple linear regression model, MEP, FEV1, and weekly time spent playing online games were significant predictors of internet addiction intensity (R2 = 0.28; p = 0.02, p = 0.01, and p < 0.001, respectively).

CONCLUSION

Postural misalignment and increased sedentary time cause physical health deterioration and negatively affect lung functions in children and adolescents with IGD. Consequently, considering both psychological and physical health is necessary to assess the problematic nature of internet gaming. A comprehensive assessment and multidisciplinary team approach is essential to managing the IGD.

Long-Term Follow-Up Result of Connective Tissue Manipulation in Young Women with Primary Dysmenorrhea: Different Intervention Durations

The purpose of this study was to reveal the effect of connective tissue manipulation (CTM) on long-term pain severity, fatigue, sleep quality, premenstrual symptom severity, general health status, anxiety, and depression in women with primary dysmenorrhea (PD). Thirty-five women with PD were divided into two groups. CTM was applied to the participants in each group on the days when they were not on menstruation between two menstrual cycles for the group 1 (n=18) and between three menstrual cycles for the group 2 (n=17). Intensity of menstrual pain, the sleep quality, and fatigue status of the participants during dysmenorrhea were evaluated by the Visual Analog Scale (VAS). Depressive symptoms and anxiety were evaluated using the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI), respectively. Also, the Premenstrual Syndrome Scale (PMSS) and the General Health Questionnaire (GHQ) were used to investigate the severity of premenstrual symptoms and mental health status during menstrual period. A significant decrease in the pain severity and fatigue of the participants was observed in both group 1 and group 2 after treatment, after 3rd, and 6th month follow-up (p=0.001). Also, this decrease lasted for 12th month follow-up after treatment in group 2 (p=0.0001). There was no statistically significant improvement in sleep quality within each group (p>0.05). Moreover, none of the parameters were significantly different between two groups (p>0.05). We can suggest that 2-cycle CTM treatment should be preferred in clinical settings to obtain long-lasting effects for decreasing pain, fatigue, and premenstrual symptoms in women with PD. CLINICAL TRIAL NUMBER: NCT04509934. Registration date: 8 November 2020.

AB0420 UNINTENTIONAL MONOTHERAPY IN RHEUMATOID ARTHRITIS PATIENTS RECEIVING TOFACITINIB AND DRUG SURVIVAL RATE OF TOFACITINIB

Background

Combination of MTX with a bDMARDs or tsDMARDs is considered the most effective treatment regimen currently available for patients with RA who have failed to respond to conventional DMARDs. However, approximately 30% of patients receive bDMARDs as monotherapy in daily clinical practice. Studies in the literature do not assess unintentional monotherapy in general. However, it is thought that some patients may switch to monotherapy unintentionally. In other words, some patients who are prescribed combination therapy switch to monotherapy without informing their physicians.

Objectives

To determine the rate of unintentional monotherapy in rheumatoid arthritis (RA) patients receiving tofacitinib and to evaluate tofacitinib survival rate.

Methods

This national, multicentre, retrospective study included patients’ data from the TURKBIO Registry. Data on demographics, clinical characteristics, disease duration and activity, comorbidities, and treatment were analysed.

Results

Data of 231 RA patients (84.8% female, median age, 56 years) were included; 153 were initially prescribed combination therapy and continued to their therapies; 31 were initially prescribed combination therapy but switched to monotherapy of their own will (unintentional monotherapy); 21 were initially prescribed monotherapy and switched to combination therapy; 26 were initially prescribed monotherapy and continued to their therapies. The combination and unintentional monotherapy groups did not differ regarding remission rate assessed by DAS28-CRP (60.5% and 70%, respectively, p=0.328). The rate of comorbidities at the time of data retrieval was significantly higher in the unintentional monotherapy group compared with the combination group (83.3% vs. 60.3%, p=0.031). Presence of comorbidities was a significant factor affecting switching to monotherapy (p=0.039, Odds ratio: 3.29, 95% CI: 1.06-10.18). Drug survival rates of the unintentional monotherapy and combination groups did not differ. The median drug survival duration of tofacitinib was 27+ months with a 1-year and 4-year drug survival rates of 89.6% and 60.2%, respectively, in the unintentional monotherapy group.

Conclusion

Although 13.4% of the study population started monotherapy unintentionally, drug survival rates of the unintentional monotherapy and combination groups were not different. Comorbidity was an important factor affecting transition from combination therapy to monotherapy.

This study was sponsored by Pfizer.

Figure 1.

Disclosure of Interests

Nevsun Inanc: None declared, Kerem Abacar: None declared, mehmet akif ozturk: None declared, Abdurrahman Tufan: None declared, Hazan Karadeniz: None declared, İsmail Sari: None declared, gercek can: None declared, Yesim Erez: None declared, yavuz Pehlivan: None declared, Ediz Dalkiliç: None declared, Tuğba Ocak: None declared, Ayse Cefle: None declared, Ayten Yazici Grant/research support from: Ayten Yazici has received project grant from Roche Pharmaceuticals, Turkey., Abdurrahman Senel: None declared, Servet Akar: None declared, Elif Durak Ediboglu: None declared, Süleyman Serdar Koca: None declared, Rabia Piskin Sagir: None declared, Sema Yilmaz: None declared, Semral Gulcemal: None declared, Özgül Soysal Gündüz: None declared, Canberk Sami Başibüyük Employee of: employee of Pfizer Pharmaceuticals, Istanbul, Turkey., Serdar Alkan Employee of: employee and shareholder of Pfizer Inc., Istanbul, Turkey., Teoman Yusuf Cesur Employee of: employee of Pfizer Pharmaceuticals, Istanbul, Turkey., Fatos Onen: None declared

Open reduction in pilon variant posterior malleolar fractures: Radiological and clinical evaluation

BACKGROUND

Pilon variant posterior malleolar (PVPM) fractures significantly disrupt joint congruency and cause tibiotalar instability. They are often underestimated and inadequately treated.

PURPOSE

This study assessed the outcomes of surgical treatment of this subtype of malleolar fracture, and examined the importance of computed tomography (CT) in diagnosis and surgical treatment.

MATERIAL AND METHODS

CT images and radiographs of 67 patients with trimalleolar ankle fractures were retrospectively analyzed. Fourteen patients (6 women and 8 men) were studied. The mean age was 37.7 (range, 21-58) years, and mean follow-up period was 17.1 (range, 12-24) months. All patients underwent open reduction. Reconstruction of the joint surface was assessed with postoperative CT images. The outcomes were assessed with the American Academy of Orthopaedic Surgeons (AAOS) and Osteoarthritis (OA) scoring systems.

RESULTS

The ratio of PVPM fractures to trimalleolar ankle fractures was 20.1%. Postoperative CT images demonstrated that anatomic reconstruction was achieved in 11 patients. The mean AAOS scores were 85.6 in Type 1 and 81.1 in Type 2 cases. The mean OA scores were 1 in Type 1 and 1.1 in Type 2 cases (P>0.05). The only statistically significant difference between the 2 groups was in osteochondral impaction (P<0.05).

CONCLUSION

CT imaging is essential for the accurate diagnosis and management of PVPM fractures. Posteromedial and posterolateral incisions enable direct exposure, and therefore facilitate joint surface reconstruction.

LEVEL OF EVIDENCE

Level IV. Retrospective study.

Poly-axial screw removal

As the use of instrumentation in spinal surgery has become common, the need for revision surgery has increased. During revision surgery one of the most difficult steps is removal of poly-axial pedicle screws, especially if no suitable revision set is available. We describe here an easy method for poly-axial screw removal. Leaving or placing a small piece of rod, attached firmly by a nut, tightens the head of the poly-axial screw. It can no longer move freely from the distal part of the screw and the screw can be removed by turning it counterclockwise with a big clamp or needle driver, which is available in almost every surgery set.

''Playstation eyetoy games'' improve upper extremity-related motor functioning in subacute stroke: a randomized controlled clinical trial

AIM

To evaluate the effects of ''Playstation EyeToy Games'' on upper extremity motor recovery and upper extremity-related motor functioning of patients with subacute stroke.

METHODS

The authors designed a randomized, controlled, assessor-blinded, 4-week trial, with follow-up at 3 months. A total of 20 hemiparetic inpatients (mean age 61.1 years), all within 12 months post-stroke, received 30 minutes of treatment with ''Playstation EyeToy Games'' per day, consisting of flexion and extension of the paretic shoulder, elbow and wrist as well as abduction of the paretic shoulder or placebo therapy (watching the games for the same duration without physical involvement into the games) in addition to conventional program, 5 days a week, 2-5 hours/day for 4 weeks. Brunnstrom's staging and self-care sub-items of the functional independence measure (FIM) were performed at 0 month (baseline), 4 weeks (post-treatment), and 3 months (follow-up) after the treatment.

RESULTS

The mean change score (95% confidence interval) of the FIM self-care score (5.5 [2.9-8.0] vs 1.8 [0.1-3.7], P=0.018) showed significantly more improvement in the EyeToy group compared to the control group. No significant differences were found between the groups for the Brunnstrom stages for hand and upper extremity.

CONCLUSION

''Playstation EyeToy Games'' combined with a conventional stroke rehabilitation program have a potential to enhance upper extremity-related motor functioning in subacute stroke patients.

A Model of Unilateral Cerebral Anterior and Posterior Anastomotic Vein Occlusion in the Rat

A new rat model of the sacrifice of the anterior and posterior cortical anastomotic veins by the microsurgical technique was used to evaluate venous infarction. 20 male Sprague-Dawley rats were used in this experiment. Small burr-holes were done over the anterior and posterior anastomotic veins. After the precise description of these vessels, bipolar coagulation and micro-scissor was used for sacrifice. Specimens were evaluated by histopathological techniques. Hemispheric swelling, midline shift, brain edema, subcortical petechial hemorrhage, infarction and necrosis were histopathological findings on the microscopic examination. Our results revealed that the sacrifice of the anterior and posterior anastomotic veins was a very successful model in the evaluation of brain damage after the disturbance to the venous circulation.

Presurgical ultrasound-assisted neuro-examination in the surgical repair of peripheral nerve injury

In spite of electrodiagnostic examinations, the determination of the precise localization of the injured site along the involved peripheral nerve may remain obscure or uncertain. Before starting the operation, a surgeon should have knowledge about the type of injury, the position of the proximal and distal nerve stumps, and the presence or absence of a neuroma and excessive perilesional scar tissue formation for orientation and planning of the surgical intervention. We hypothesized that real-time ultrasound could be helpful in the determination of the type of injury, the localisation of proximal and distal nerve stumps, as well as for diagnosing a neuroma. Fourteen patients with traumatic peripheral nerve injuries that were verified by neurological examinations and electrodiagnostic tests underwent surgical repair, and were examined by ultrasound before and during the surgical intervention. Visualisation of the injured site, the type of the injury, the position of the nerve stumps and the diagnosis of the neuroma were reliably feasible in all the patients by using ultrasonography. Axonal swelling of a nerve was diagnosed in 4 (29 %) patients, a stump neuroma was diagnosed in 3 (21 %) patients, a total nerve interruption (neurotmesis in the Seddon classification) was diagnosed in 9 (64 %) patients, and surrounding scar tissue was diagnosed in 5 (35 %) patients. Presurgical and intraoperative ultrasound-assisted neuroexamination is a useful diagnostic method in the determination of the precise localisation of the injured site, the type of injury, the position of stumps, and the diagnosis of a neuroma. The use of preoperative and intraoperative ultrasound can enhance the orientation of the surgeon to the surgical field. The application of our method to our patients shows that presurgical ultrasonographic neuroexamination can be used in the surgical repair of peripheral nerve injury.

Transparent microballoon dissection in the surgical treatment of brain tumors

In spite of maximal microsurgical efforts, perilesional neural tissue can be injured by surgical instruments in the process of the separation and dissection of tumors. We hypothesized that transparent microballoon dissection could be helpful in the gentle separation of brain tissue from tumor by minimizing cerebral damage, and in separating sulcal and cisternal walls during surgical interventions on brain masses. We used the transparent microballoon dissection technique in 3 primary cases and 4 metastatic brain tumors that were verified with computed tomography (CT) and magnetic resonance imaging (MRI). Gentle separation of tumor from surrounding brain, reduction of cerebral damage, and separation of sulcal and cisternal walls were feasible in all patients. Postoperative CT and MRI showed satisfactory results in reducing perilesional cerebral damage. The transparent microballoon inflation technique is a useful microsurgical method for the gentle separation of tumors from surrounding brain tissue, minimizing cerebral damage, and separating sulcal and cisternal walls during surgical interventions for brain masses. Our conclusion is that using the microballoon dissection method may be suitable in microneurosurgical practice.

Reconstruction of burr hole by using autologous button-shaped graft harvested from inner table of craniotomy flap: technique and clinical result

Patients who underwent craniotomy occasionally complain about the postoperative cosmetic appearance at the site of burr holes on the scalp. This problem occurs as a result of depletion of the skin into the unreconstructed burr holes. Some materials have been developed for reconstruction of craniotomy burr holes. To prevent the postoperative cosmetic deformity, the authors developed a button-shaped autologous bone graft harvested from the inner table of craniotomy flap. Clinical application of this method is described.

Cerebral Aneurysms in Behçet's Disease: A Case Report

A 42-year-old male patient was surgically treated for two cerebral aneurysms, 18 months later he developed manifestations of Behçet's disease. Lack of clinical manifestations as well as angiographic evidence of vasculitis at the time of the cerebral aneurysmal disease argue against the possibility that the aneurysms were complications of the neural involvement of Behçet's disease.

The guidance of intraoperative ultrasonography in the surgical treatment of arteriovenous malformation

In this operative case-based report, we have investigated the ability and benefits of intraoperative grey-scale sonographic examination in the localising of arteriovenous malformations in the brain, the identification of feeding artery or arteries, the description of perilesional changes, and the detection of accompanying hematomas. The surrounding edematous brain tissue was observed as hyperechioc areas. The arteriovenous malformation appeared in two echogenic parts, a hyperechioc thrombotic part and a hypoechoic perfused part. We were able to identify the feeding artery. The sonographic characteristics of this artery are thick vascular wall, the presence of arterial systolic pulsation and a close relation with the nidus. We conclude that intraoperative ultrasonographic examination during the surgical treatment of arteriovenous malformation is a non-invasive, useful, and simple diagnostic tool in the detection of the components and accompanying parts of the lesion.

Spontaneous disappearance of two asymptomatic arachnoid cysts in two different locations

We report two children with asymptomatic arachnoid cysts which resolved spontaneously without any surgical intervention and history of major head and body trauma. The first child was a 10-year-old boy with an arachnoid cyst in the right sylvian fissure. The second child was a 1-year-old girl with a right cerebral convexity arachnoid cyst. Both of them were asymptomatic. Arachnoid cysts spontaneously disappeared within 2 years following initial diagnosing. There was no major head and body trauma except usual home, school and sports activity. We speculated that the cysts ruptured into cerebrospinal fluid circulation by the mechanical effects of some forced activities to the brain tissue and cyst, such as excessive breathing, coughing and sport activities. These factors may change the balance between intracystic and pericystic pressure and facilitate the rupturing of the cyst into subdural, subarachnoid and intraventricular spaces. These cases demonstrate that neurosurgical intervention of asymptomatic arachnoid cysts is not absolutely indicated in the paediatric age group. Close follow up with computerized tomography (CT) and magnetic resonance imaging (MRI) is a treatment option in the patient with arachnoid cysts located in the middle cranial fossa and cerebral convexity.

The effects of albendazole solution at scolocidal concentration in the rat brain

Intra-operative cyst rupture is a catastrophic event in the intracranial hydatid cyst disease. Dissemination of the cyst contents may lead to severe anaphylactic reactions and an increased risk of recurrence. Several scolicidal agents have been used to eradicate the infective scolices but recurrences occur and no solution has been evaluated for its adverse effects to the brain tissue. Being a specific scolocidal agent albendazole has been shown to be 100% scolicidal in vitro. In this study, we present the electrophysiological and histopathological effects of intracerebral 2% albendazole injection in the rat brain. Vascular, neuronal and glial as well as inflammatory changes were evaluated in order to detect any adverse pharmacological effects. Electrophysiological and most microscopic parameters showed no significant effects attributable to albendazole but in 25% of the albendazole group cerebral gliosis was detected whereas no gliosis was present in the control group. It is concluded that being a specific scolicidal agent albendazole offers an efficient alternative for ruptured cerebral hydatid disease, but the significance and clinical importance of the gliosis should be further investigated.

Acute interhemispheric subdural hematomas. Report of nine cases

Nine male patients with acute interhemispheric subdural hematoma (ISH) are presented. The etiologic factor was trauma for all patients (traffic accident and falling down). The young adult cases and one child had bad prognosis due to severe clinical findings and high mortality. The asymptomatic patients were treated conservatively. In this report, we discussed etiologic factors, presentation of age groups, whether an ISH progresses to a chronic convexity subdural hematoma (SH), and real mortality rates for ISH with relevant literature knowledge. As a result, ISHs can present in all age groups including shaken babies, severely injured young adults as well as low velocity trauma striken elderly patients (especially those under anticoagulant medication). We believe that an acute ISH does not change to chronic convexity SH; in fact they present as simultaneous acute thin convexity SH and acute ISH. It is also concluded that in contrast to previous literature ISH and acute SH patients of similar neurological status have similar mortality rates.

Serum erythrocyte and leukocyte adenosine deaminase activities in patients with vivax malaria in Turkey

Adenosine deaminase (ADA) activities in serum samples, erythrocytes, leukocytes and plasma hemoglobin concentrations were investigated in 50 patients with vivax malaria and compared with control group. ADA activity was determined by Bertholet reaction. Student's t-test and correlation analyses methods were used for statistical analyses. Serum ADA activity in patients with vivax malaria 49.20 +/- 29.02 IU/I, in control 21.15 +/- 8.04 IU/I (p = 0.005), erythrocyte ADA activity in patients 2.91 +/- 1.23 U/gr Hb, in control 1.65 +/- 0.59 U/gr (p = 0.001), leukocyte specific ADA activity in patients 26.23 +/- 20.21 U/mg protein, in control 25.84 +/- 9.19 U/gr Hb were determined (P > 0.05). Plasma hemoglobin concentration in patients 29.25 +/- 28.10 ml/dl, in control 9.80 +/- 13.14 mg/dl were also determined. There is no significant correlation among mentioned parameters. Erythrocyte purine salvage pathway is accelerated by Plasmodium to provide preformed purine source which can not be synthesized by Plasmodium to provide preformed purine source which can correlation between plasma hemoglobin concentration and serum ADA activity suggests that increased serum ADA activity may develop secondarily to the disease independently from the hemolyses. No higher ADA activity level than expected value of leukocytes may reflect immunosuppression of leukocytes.

Quantitative assessment of the normal adult spinal canal at the fourth lumbar vertebra by computed tomography

We reviewed the computed tomographic (CT) studies of 105 adults with various complaints. Spinal canal diameters were measured by CT using both the conventional and Jones-Thomson (JT) techniques at the level of the fourth lumbar vertebra. The data were statistically assessed in an attempt to define spinal stenosis.