Objectives This study aims to evaluate the efficacy of extracorporeal shock wave therapy (ESWT) in carpal tunnel syndrome (CTS) compared to the wrist splint treatment. Patients and methods Between April 2016 and March 2017, a total of 189 patients (22 males, 167 females, mean age 48.8±9.5 years, range, 24 to 70 years) with mild-to-moderate CTS were included in this double-blind, prospective, randomized, placebo-controlled study. The patients were divided into four treatment groups using stratified randomization: splint group (Group 1, n=47), splint+ESWT (Group 2, n=47), ESWT (Group 3, n=45), and splint+placebo ESWT (Group 4, n=50). All patients were evaluated at baseline, and one and three months. Pain using the Visual Analog Scale (VAS), finger pinch strength, Boston Carpal Tunnel Questionnaire (BCTQ), Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), and electrophysiological examination were assessed. Results A total of 168 patients completed the study. There was no significant difference among the four groups in terms of age, sex, comorbid diseases, symptom duration, VAS-pain, BCTQ, and LANSS scores (p>0.05). Pain and functionality significantly improved in all groups (p<0.05). In the group with ESWT and using wrist splint combined, a greater improvement of the hand function and electrophysiological measures was observed. Conclusion Our study results show that ESWT is a valuable and reliable treatment modality for mild-to-moderate CTS.

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Objectives To determine the seroconversion (SC) rate after CoronaVac and BNT162b2 vaccines in adults with inflammatory rheumatic disease (IRD). Methods Patients who were followed up with IRD and who received two doses of either CoronaVac or BNT162b2 vaccines were included in this prospective observational single-center study. Subjects with two doses of CoronaVac or BNT162b2 without known IRD were included in the healthy controls. The blood samples were taken at a minimum of two and a maximum of 12 weeks after the second dose of vaccine. Results A total of 81 patients with IRD (61 CoronaVac, 20 BNT162b2) and 100 healthy controls (70 CoronaVac, 30 BNT162b2) were included. The SC rate was slightly lower among patients with IRD versus controls (84 vs 97%, p = 0.002). The SC rate was 100% in all participants who received BNT162b2 both in the patient and control group. The IgG antibody level after CoronaVac in the patient group was significantly lower than both the BNT162b2 ( p = 0.031) and the healthy group ( p < 0.001). Among patients with IRD, those on rituximab (RTX) (12/81,14.8%) had significantly less SC rate (5/12, 41.7%). The median neutralizing antibody titers were significantly higher in patients with BNT162b2 compared with CoronaVac (1.97 vs. 16.34, p < 0.001). Conclusions This study showed that all patients with BNT162b2 vaccine developed immunogenicity in patients with IRD, while there was a decreased antibody response with CoronaVac vaccine compared to that of BNT162b2. In particular, RTX significantly reduces the SC rate.

Objective The aim of the study was to detect the frequency and course of coronavirus disease 2019 (Covid‐19) infection among our rheumatology outpatients and to investigate how patient follow‐up differed during Covid‐19 pandemic in a tertiary University Hospital in the capital of Turkey. Patients and method Patients with inflammatory rheumatic diseases (IRDs) registered in our rheumatology clinic were assessed during their routine outpatient follow‐up control or contacted via phone between July and December 2020. Patients' demographics, diagnosis, medication, comorbidities, frequency of going outside during the pandemic, work status, whether patients could attend their routine follow‐up, treatment changes, access to drugs during the pandemic, and the incidence of Covid‐19 infection were collected. Results A total of 320 patients with IRD were analysed; 114 (35.6%) patients were treated with conventional synthetic disease‐modifying antirheumatic drugs (csDMARDs) (methotrexate/leflunomide/sulfasalazine), 93 (29.1%) patients with biologic DMARDs (bDMARDs), 113 (35.3%) patients with glucocorticoids, and 103 (32.2%) patients with hydroxychloroquine (HCQ). A total of 15.9% of patients on HCQ experienced problems in medication supply. Only 87 (27.2%) patients presented for their routine follow‐up appointment, and 38 (11.9%) of the patients changed their treatment without professional health advice. While 53 (57%) patients on biological agents continued their treatment, 31 patients (33.3%) interrupted the treatment with doctor's recommendation and 9 patients (9.6%) on their initiative, and 23 of these 31 patients had to restart treatment because of disease activation. The nasopharyngeal swab collected from 30 patients with a suspected Covid‐19 contact but without any symptoms was negative. In total, there were 33 patients diagnosed with Covid‐19; none of whom had severe respiratory complications or death. Conclusions Many patients with rheumatic diseases are left without disease monitoring during the pandemic. There was no increased risk of severe Covid‐19 infection among patients with IRD.

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Background: Vacuum-assisted suspension systems provide better suspension than non-vacuum systems, but data are limited on whether they improve physical activity levels and quality of life for people with amputation. Objectives: To compare the physical activity and quality of life levels of people with transtibial amputation using PIN/LOCK suspension system or vacuum-assisted suspension systems with those of able-bodied controls and to investigate parameters associated with physical activity levels. Study design: A cross-sectional observational study. Methods: Fifty-one people with amputation and 51 controls participated. The International Physical Activity Questionnaire Short Form and Short Form 36 were used to measure the physical activity and quality of life, respectively. Results: The total physical activity and Short Form 36 scores were significantly lower in the participants with amputation than the controls. There were no significant differences between the two types of suspension systems in terms of physical activity levels and quality of life. The vacuum-assisted suspension system users reported significantly more bodily pain on the Short Form 36 questionnaire than the controls ( p = 0.003). The only parameter that correlated significantly with the total physical activity was the Short Form 36 physical functioning subscale ( r = 0.302, p = 0.031). Conclusion: Contrary to our expectations, vacuum-assisted suspension system users compared to PIN/LOCK users did not report greater levels of physical activity or improved quality of life or levels closer to comparable controls. Clinical relevance A better understanding of the effects of different prosthetic suspension systems on physical activity and quality of life may help clinicians when prescribing prostheses, as well as setting appropriate prosthetic expectations. This study suggests that vacuum-assisted suspension systems and PIN/LOCK suspension systems provide equal benefit to users with regards to physical activity and quality of life.

Background:Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy that occurs as a result of median nerve compression at the wrist. Extracorporeal shock wave therapy (ESWT) is specified as a treatment with high amplitude acoustic waves that focus on a region of the body. While ESWT is frequently used to treat musculoskeletal disorders such as plantar fasciitis and tendinitis, in recent years ESWT has become a new treatment option in CTS. Positive results have been reported from limited number of studies which were assessed efficacy of ESWT in CTS treatment. On the other hand it is noteworthy that the number of patients in these studies is not high and there is no clear consensus on the concept of shock wave energy density and frequency due to lack of experience (1,2,3).Objectives:To evaluate the efficacy of ESWT in CTS and compared to wrist splint treatment in this prospective, randomized double-blind, placebo-controlled trial.Methods:One hundred eighty-nine patients with mild/moderate CTS were included. Patients were assigned to 4 different treatment groups (1-Splint, 2-Splint+ ESWT, 3-ESWT, 4-Splint+ placebo ESWT) by using stratified randomization to ensure balance of the treatment groups respect to the various combinations of the prognostic variables in terms of in terms of age, gender, and severity of CTS. 168 patients completed the study at third month. ESWT was performed on the area included 2 cm proximal to the pisiform bone. It was applied with 1000 shots, 0.05 mJ/mm2 intensity of energy and frequency of 5 Hz. (3 weeks, once a week). Wrist splint with suitable size and neutral position was suggested. Patients were evaluated at baseline, first and third month. Pain, finger pinch strength, Boston Carpal Tunnel Questionnaire (BCTQ), Leeds Neuropathic Symptom and Finding Assessment (LANSS) and electrophysiological examination were assessed.Results:Demographics, clinical characteristics of the patients are shown in table 1. Significant pain and functionality improvement was found in all groups (p<0.05) at first and third months. The improvements in clinical and electrophysiological variables were compared between four groups In group 2, baseline- first month finger pinch increase was higher than groups 1 and 4, and the baseline- third month finger pinch increase was higher than group 4. In group 2, the increase in mMNCV was higher than group 1.Table 1Baseline demographic and clinic characteristics of patientsConclusions:In the group with ESWT and using wrist splint together, it was found that the improvement of hand function and electrophysiological measures was higher than other groups. ESWT, a valuable and practical treatment modality without serious side effects, reduces pain, neuropathic symptoms, disability and improves electrophysiological findings for patients with mild to moderate CTS.References1. Seok H, Kim SH. The effectiveness of extracorporeal shock wave therapy vs. local steroid injection for management of carpal tunnel syndrome: a randomized controlled trial. Am J Phys Med Rehabil2...

BackgroundHaving an autoimmune disease was an exclusion criterion in the efficacy and safety phase studies of vaccines against Covid-19 (1-2). In Turkey vaccination first started with the inactivated CoronaVac, then with the mRNA BNT162b2 vaccine. Although there are studies on vaccine efficacy and safety in adults with inflammatory rheumatic disease (IRD), there are still many unknowns (3-4).ObjectivesPrimary outcome of this study is to determine the seroconversion (SC) rate after CoronaVac and BNT162b2 vaccines in adults with IRD and to compare it with a healthy control group. Secondary outcomes are to evaluate whether there are efficacy differences in the two vaccine types, and to investigate the effects of the biologic agent used in the patient group on the vaccine immunogenicity.MethodsThis prospective observational single center study was conducted at the Gazi University Hospital. Patients who were followed up in our outpatient clinic with IRD and who received two doses of either CoronaVac or BNT162b2 vaccines were included. Subjects with two doses one of these vaccine without IRD were included in the healthy control group. Patients who had Covid-19 infection before or during vaccination were excluded. The demographic characters were recorded. The interval between the two doses was 4 weeks. The blood samples of the patient and control groups were taken a minimum of two and a maximum of 12 weeks after the second dose. Anti-S antibodies against SARS-CoV-2 spike proteins were evaluated with the IgG Abbott kit, and a value above 50 arbitrary unit/ml was considered as positive SC. The neutralizing antibody titers were evaluated with the DIA.PRO kit, and cut-off value was above 1 Co/S.ResultsThe SC rate was slightly lower among patients with IRD versus controls (84% vs 97%, p:0.002). The SC rate was 100% in all participants who received BNT162b2 both in the patient and control group. The IgG antibody level after CoronaVac was significantly lower than that of BNT162b2 vaccine (p:0.031) in both patient and healthy controls (p:0.001). Among patients with IRD, those on rituximab (RTX)(12/81, %14.8) had significantly less SC rate (5/12, 41.7%) compared to patients on other biologicals (63/69, 91.3%) (p<0.001).ConclusionThis study showed that all patients with BNT162b2 vaccine developed immunogenicity in patients with IRD, while there was a decreased antibody response with CoronaVac vaccine compared to the healthy control group. In particular, the use of RTX significantly reduces the SC rate.References[1]Polack FP, Thomas SJ, et al. Safety and efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med. 2020 383(27):2603–2615.[2]Tanriover MD, Doğanay HL, et al. Efficacy and safety of an inactivated whole-virion SARS-CoV-2 vaccine (CoronaVac): interim results of a double-blind, randomised, placebo-controlled, phase 3 trial in Turkey. Lancet. 2021 Jul 17;398(10296):213-222.[3]Medeiros-Ribeiro AC, Aikawa NE, et al. Immunogenicity and safety of the CoronaVac inactivated vaccine in patients with autoimmune rheumatic diseases: a phase 4 trial. Nat Med. 2021 Oct;27(10):1744-1751.[4]Furer V, Eviatar T, et al. Immunogenicity and safety of the BNT162b2 mRNA COVID-19 vaccine in adult patients with autoimmune inflammatory rheumatic diseases and in the general population: a multicentre study. Ann Rheum Dis. 2021 Oct;80(10):1330-1338.Table 1.Patients with IRD n:81Healthy controls n:100P valueAge (mean±SD)50.65±1.3750.65±1.37Female5865-RA35N/A-SpA14-CTD20-FMF4-Vasculitis8-CoronaVac6170-BNT162b22030Seroconvertion rate (%)68/81 (84%)97/100 (97%)0.002-CoronaVac48/6167/70-BNT162b220/2030/30IgG (median) (IR)0.001-CoronaVac275.8 (68.95-916.70)1116.7 (477.70-2074.18)-BNT162b24007.20 (1904.65-10415.25)5792.30 (3696.42-9419.85)Neutralization (median) (IR)p: 0.031p: 0.552-CoronaVac1.97 (0.92-6.82)N/A-BNT162b216.34 (13.85-16.67)bDMARD/Seroconvertion rate (%)p: 0.001N/A-naive52/58-RTX5/12-Anti-cytokine11/11AcknowledgementsResearch support from:TRASD (Turksih League Against Rheumatism)Disclosure of InterestsNone declared