Objective
To explore the effects of aerobic training adding to home-based exercise program on motor function and muscle architectural properties in children with Duchenne muscular dystrophy.
Design
...This is a prospective randomized controlled study.
Setting
Pediatric neuromuscular clinic in a tertiary care center.
Subjects
Children with Duchenne muscular dystrophy.
Interventions
Children were randomly divided into two groups whereby 12-weeks aerobic training was additionally given in treatment group in contrast to the control group which received only home-based exercise program.
Main Measures
Motor Function Measure and Six Minute Walk Test were used for clinical evaluation, and muscle architectural properties (thickness, pennation angle and fascicle length) were measured by ultrasound imaging. Both groups were assessed at baseline and after 12-weeks of training.
Results
Median age of children was 7.9 years in the treatment group and 8.6 years in the control group (p > 0.05). Significant improvements were obtained for Motor Function Measure and Six Minute Walk Test from baseline to 12-weeks in the treatment group; Motor Function Measure total score changed from 83.2 (6.1) to 86.9 (4.0) vs. 82.3 (10.2) to 80.4 (9.4) points in the control group (p = 0.006); 6 Minute Walk Test distance changed from 395.3 (46.6) to 413.0 (52.3) vs. 421.7 (64.4) to 393.8 (68.2) meters in the control group (p < 0.001). However, muscle architectural parameters did not change during study period (p > 0.05).
Conclusion
Aerobic training may be of additional value in improving motor function and performance with no remarkable effect on muscle architectural properties.
Urban wastewater in Turkey is primarily discharged without treatment to marine environments, streams and rivers, and natural and artificial lakes. Since it has been well established that untreated ...effluent in multi-use waters can have acute and chronic impacts to both the environment and human health, it is important to evaluate the consequences of organic enrichment relative to the structure and function of aquatic environment. We investigated the impacts of untreated municipal wastewater discharge from the city of Gumushane in the Eastern Black Sea Region of Turkey on the surface water quality of the stream Harsit. Several key water-quality indicators were measured: chemical oxygen demand (COD), ammonium nitrogen (NH
4
+
–N), nitrite nitrogen (NO
2
−
–N), nitrate nitrogen (NO
3
−
–N), total Kjeldahl nitrogen (TKN), total nitrogen (TN), orthophosphate phosphorus (PO
4
3−
–P), methylene blue active substances (MBAS), water temperature (
t
), pH, dissolved oxygen (DO), and electrical conductivity (EC). The monitoring and sampling studies were conducted every 15 days from March 2009 to February 2010 at three longitudinally distributed stations. While
t
, pH, DO, and EC demonstrated relatively little variability over the course of the study, other parameters showed substantial temporal and spatial variations. The most dramatic differences were noted in COD, NH
4
+
–N, NO
2
−
–N, TKN, TN, PO
4
3—
P, and MBAS immediately downstream of the wastewater discharge. Concentration increases of 309 and 418 % for COD, 5,635 and 2,162 % for NH
4
+
–N, 2,225 and 674 % for NO
2
−
–N, 283 and 478 % for TKN, 208 and 213 % for PO
4
3−
–P, and 535 and 1,260 % for MBAS were observed in the summer and autumn, respectively. These changes were associated with greatly diminished seasonal stream flows. Based on NO
2
−
–N, TKN, PO
4
3—
P, and MBAS concentrations, it was concluded that Harsit stream water was correctly classified as polluted. The most telling parameter, however, was NH
4
+
–N, which indicated highly polluted waters in both the summer and autumn. The elevated concentrations of both P and N in the downstream segment of the stream triggered aggressive growth of submerged algae. This eutrophication of river systems is highly representative of many urban corridors and is symptomatic of ongoing organic enrichment that must be addressed through improved water treatment facilities.
Objective
The aims of this study were (a) to examine the surface electromyography (sEMG) amplitude values of the lower limb muscles during stair climbing both between different functional levels of ...Duchenne muscular dystrophy (DMD), in comparison with healthy children, and (b) to investigate the relationships between sEMG amplitudes and physical performance.
Methods
sEMG amplitudes of the lower limbs of twenty-one children with DMD between levels I and III according to the Brooke Lower Extremity Functional Classification Scale and eleven healthy peers were evaluated by using sEMG during stair climbing task. Physical performance was evaluated by 6-min walk test and ascending 4-step timed performance test.
Results
The lower limb sEMG amplitude values of children with DMD were statistically higher than healthy children (
p
< 0.001). sEMG amplitudes of the right (
p
= 0.01) and left (
p
= 0.003) biceps femoris, the right (
p
< 0.001) and left (
p
= 0.001) gastrocnemius medialis, and the right vastus lateralis (
p
= 0.02) muscles were higher in children with levels 2–3 than those in level 1. Moderate-to-strong relations were found between the gastrocnemius medialis and biceps femoris sEMG amplitudes and physical performance assessments (
p
< 0.05).
Conclusion
Increased sEMG amplitude values in the lower limbs during stair climbing task are thought to be caused by the effort to compensate for progressive muscle weakness and are associated with lower physical performance in children with DMD. Further, sEMG amplitude values are determined to increase as the functional level deteriorates.
Clinical trial registration number and URL
NCT04287582 (
https://clinicaltrials.gov/ct2/show/NCT04287582?term=merve+bora&draw=2&rank=1
).
ABSTRACT
Background:
Muscle imaging methods such as ultrasound and magnetic resonance imaging have been used for many years to determine the dystrophic process in muscular dystrophies. However, the ...knowledge regarding muscle architecture in children at early-stage Duchenne muscular dystrophy (DMD) with different functional levels is limited.
Objective:
To explore the effect of functional level on muscle architectural properties in children with early stage DMD and the difference between DMD and typically developing (TD) peers.
Methods:
Thirty children with DMD (15 Grade 1 and 15 Grade 2 according to the Vignos Scale) and 5 TD peers were included. Ultrasound imaging was used to measure muscle thickness (MT), fascicle length (FL), and pennation angle (PA) of vastus lateralis (VL) and medial gastrocnemius (MG) muscles bilaterally.
Results:
The MT and FL values for VL, and MT, FL and PA values for MG muscles were higher in children with DMD compared with those of TD peers (p<0.05). The FL of VL, and MT and FL of GM muscles of children with DMD Grade 2 were higher than those of children with DMD Grade 1 (p<0.05).
Conclusions:
MT and FL are increased in children with DMD compared with TD peers. Additionally, muscle architecture seems to be affected even at the early stages of the disease.
A healthy 21-year-old woman was presented to our outpatient clinic with an asymptomatic swelling on her left arm. She reported the administration of two doses of BNT162b2 mRNA vaccination at the ...lesion site earlier. The pathology report confirmed the diagnosis of pilomatricoma. Previously, needlestick trauma and various immunisations have been attributed to the development of pilomatricoma. We present this case to emphasise the possible association between BNT162b2 mRNA vaccination and pilomatricoma development. The role of persistent inflammation is also discussed.
Duchenne muscular dystrophy (DMD) is a disease characterized by progressive loss of muscle fiber, gradually from proximal to distal. Although a few studies have investigated hand grip strength in ...non-ambulatory DMD patients, a lack of literature was found determining its relationship with functional capacity.
The aim of this study was to determine the associations between hand grip strength and functional measures in non-ambulatory children with DMD.
Hand grip strength was evaluated using a dynamometer in children with DMD. The children with DMD were evaluated with the Turkish version of the Egen Klassifikation Scale Version 2 (EK2) for global functional capacity, the Performance of Upper Limb (PUL) for upper limb functional performance and the ABILHAND-Kids for hand ability.
The mean age of 38 DMD children was 12.02 ± 1.99 years. Dominant hand grip strength of the children with DMD was higher than the non-dominant hand (p < 0.05). The EK2 was 13.02 ± 5.50, PUL was 49.86 ± 14.34 and ABILHAND-Kids was 26.81 ± 7.59. Hand grip strength was found to be correlated with the EK2 (p < 0.05).
It is known that measuring functional ability and strength in very weak children with DMD has been difficult and complex for therapists/clinicians in the clinical environment. Although there is a moderate correlation, hand grip strength may be used in clinical practice as a practical assessment tool to have an immediate insight into the global functional capacity in non-ambulatory DMD children.
Bladder paraganglioma is a neuroendocrine tumor that accounts for less than 0.1% of all bladder tumors. Symptoms caused by catecholamine release such as hypertension, palpitation, syncope, and ...macroscopic hematuria are the most common findings. Treatment modalities include transurethral resection, and partial or total cystectomy.
A 38-year-old Turkish female patient was examined for hematuria that had been persisting for 6 months. Among the clinical findings, only hematuria was present. Absence of adrenergic symptoms such as hypertension, palpitations, and syncope at the first presentation made it difficult to consider bladder paraganglioma in the differential diagnosis. Therefore, cystoscopy and transurethral resection were performed with the thought of urothelial cancer. Findings such as hypertension and bradycardia that developed during diagnostic transurethral resection suggested that it might be bladder paraganglioma. After the radiological evaluation and endocrinological preparation, the patient underwent partial cystectomy.
The rarity of cases having been reported in the literature leads to uncertainties in the management of bladder paraganglioma. Adrenergic symptoms developing during transurethral resection should suggest paraganglioma in the differential diagnosis. A multidisciplinary approach and medical treatment are mandatory to prevent life-threatening complications such as hypertensive crisis, vascular collapse, and multiple-organ system failure. We aimed to report the clinical presentation that includes only macroscopic hematuria mimicking urothelial cancer and to emphasize the multidisciplinary approach in the treatment.
This paper presents a comprehensive evaluation of drinking water quality from the stream Galyan and its tributary, the stream Kuştul, in Trabzon Province, Turkey. In this study, surface water quality ...data for 20 physical and chemical parameters were determined and collected from three monitoring stations of the understudy stream during April 2004 to March 2005. According to the Turkish Water Pollution Control Regulation, the stream Galyan water was classified, and the studied parameters were evaluated for the values proposed by Turkish Standard (TS) 266 and World Health Organization (WHO) guidelines. The results showed that TS 266 and WHO guidelines were exceeded for Fe (up to 860 μg/l) and Cr (up to 134.7 μg/l). Pearson's correlation was also used to determine the relationship of the studied parameters and as a result significant correlations were observed between some parameters.
Abstract Introduction This study was planned to compare the static and dynamic balance in children with DMD at different functional levels with each other and with healthy peers. Material and Methods ...Sixty nine children between the ages of 6 and 11 were included in this study where 52 of them were diagnosed with Duchenne Musclar Dysthropy (DMD) in Level I (18 patients), Level II (17 patients), and Level III (17 patients) according to Brooke Functional Classification Scale and 17 of them healthy peers were included. In order to assess static and dynamic balance pediatric functional reach test (PFRT) and timed up and go test (TUGT) were used. Results When compared in terms of the TUGT, differences were found between all groups, i.e. Level 1 and 2, Level 2 and 3, Level 1 and 3, Healthy peers and Level 1, Healthy peers and Level 2, and Healthy peers and Level 3 (p<0.0083). When compared in terms of the PFRT in the standing positions, there was difference between level 3 and healthy peers(p<0.0083), but not between the other groups. Conclusions We found poor functional level in DMD to affect the dynamic and static balance parameters in this study. The dynamic balance of a child with DMD at Level 3 is decreased to a third of a healthy peer.
A new method using a column packed with Amberlite XAD-2010 resin as a solid-phase extractant has been developed for the multi-element preconcentration of Mn(II), Co(II), Ni(II), Cu(II), Cd(II), and ...Pb(II) ions based on their complex formation with the sodium diethyldithiocarbamate (Na-DDTC) prior to flame atomic absorption spectrometric (FAAS) determinations. Metal complexes sorbed on the resin were eluted by 1
mol
L
−1 HNO
3 in acetone. Effects of the analytical conditions over the preconcentration yields of the metal ions, such as pH, quantity of Na-DDTC, eluent type, sample volume and flow rate, foreign ions etc. have been investigated. The limits of detection (LOD) of the analytes were found in the range 0.08–0.26
μg
L
−1. The method was validated by analyzing three certified reference materials. The method has been applied for the determination of trace elements in some environmental samples.
PDF
