OBJECTIVES:To investigate the presence and severity of central sensitization (CS) and its associations with clinical measures and quality of life (QoL) in individuals with a history of paralytic poliomyelitis with and without post-polio syndrome (PPS). METHODS:In this cross-sectional study, we included 98 individuals with a history of poliomyelitis, in whom 82 (83.6%) met the criteria of PPS. We used CS Inventory (CSI) to evaluate the presence and severity of CS. We evaluated the severity of fatigue, pain, polio-related impairments, and QoL using a Numerical Rating Scale in addition to Fatigue Severity Scale, Self-reported Impairments in Persons with late effects of Polio rating scale (SIPP), and Nottingham Health Profile (NHP). RESULTS:CS was present in 52.4% of patients with PPS, of which 63% are classified as severe to extreme. Those with CS reported more severe symptoms, more polio-related impairments, and worse QoL than those without CS. Severity of CS showed significant positive correlations with severity of fatigue, pain, SIPP, and NHP scales in those with PPS. CSI did not indicate CS in any of those without PPS. CONCLUSION:CS was present in more than half of the individuals with PPS and correlated with more severe pain, fatigue, and more polio-related impairments, in addition to poorer QoL. These findings suggest that CS may contribute to the clinical picture in a subgroup of individuals with PPS. Thus, identification and appropriate management of CS patients may potentially help alleviate their symptoms and improve their QoL.

Objective: The aim of this study was to assess the presence of neck pain, which is one of the most common musculoskeletal disorders in nurses, in terms of different work environments, and also to assess the possible relationships of ergonomic, demographic, and psychological factors on their neck pain. Materials and Methods: Female nurses from our university hospital that worked in outpatient clinics, wards and intensive care units were included in this cross-sectional study. It was carried out between February and July 2020 in different departments of our university. Patient demographics as well as duration and characteristics of neck pain, Short form-36 (SF-36) questionnaire scores were recorded. Results: A statistically significant relationship was found between units that the subjects worked in and emergence of neck pain due to the presence of triggering factors such as computer use, heavy lifting and the presence of neck pain for the last month (p<0.05). The presence of neck pain in the previous month was found to be statistically correlated with presence of comorbid diseases (p<0.05), while no statistically significant relationship was found between fatigue, stress, education level, marital status and presence of neck pain (p<0.05). Conclusion: Musculoskeletal pain is reported to be common in healthcare workers. Nurses are also known to be among the occupational groups at serious risk for painful conditions. Lack of proper working conditions and lifestyle are among the causes of neck pain in nurses. In our study, a statistically significant relationship was found between neck pain and conditions that are not suitable for ergonomics such as prolonged computer exposure and heavy lifting.

The authors have requested that this preprint be removed from Research Square.

BackgroundPrimary lymphedema is the most common form of lymphedema presenting in the pediatric age group. Childhood lymphedema is caused by hereditary or congenital malformations in the lymphatic system that can manifest at birth or during childhood or adolescence.ObjectivesComplex decongestive therapy (CDT) is the cornerstone of conservative management of lymphedema in both adult and pediatric lymphedema patients, although pediatric treatment guidelines are still lacking. In this study we aimed to assess the effects of CDT on pediatric patients.MethodsChildhood lymphedema patients who presented to the lymphedema rehabilitation unit of our university hospital before the age of 18 and who were treated for lymphedema with CDT were included in the study. Data on patient demographics, disease characteristics, and treatment duration were recorded. Limb volumes were calculated from patient measurements using a spreadsheet software (Limb Volume Calculator) that utilized the geometric formula for volume of a truncated cone. Measurements were taken before treatment and also weekly after initiation of treatment. Percent excess volume (PEV) was used instead of absolute volume difference to define the severity of lymphedema.ResultsA total of 34 limbs from 24 patients were included in the study. The mean age of the patients was 10.1 ± 4.9 years and 14 (58.3 %) were female. Most patients had one affected limb but 16 had bilateral lower-extremity lymphedema. The mean duration of treatment with CDT was 153.6 ± 155.8 days. Excess volume percentage change between pre-treatment PEV (602.8 ± 713.8) and post-treatment PEV (514.6 ± 699.1) was found to be statistically significant (p < 0.05).ConclusionPediatric lymphedema management is a difficult and less well studied area in lymphedema rehabilitation. Our data support the use of CDT, which is a safe and effective treatment method, for pediatric lymphedema patients.

Objectives: This study aimed to investigate the effects of different carrier frequencies of interferential current (IFC) treatment on a Visual Analog Scale (VAS) for pain, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), 10-m walk test, and the amount of paracetamol taken. Patients and methods: The double-blind, randomized controlled study included 61 patients (16 males, 45 females; mean age: 63.7±9.8 years; range, 50 to 80 years) with knee osteoarthritis who were randomized to three treatment groups: 2,000 Hz, 4,000 Hz, and 8,000 Hz. The study was conducted between February 2019 and October 2019. Subjects received IFC treatment for 20 min five times per week for three weeks. All subjects were prescribed a home exercise program. Patients were evaluated at baseline and at three and seven weeks. The primary outcome was VAS to assess knee pain. Results: Treatment with IFC yielded significant results in VAS pain, WOMAC pain, and WOMAC function parameters in all three groups, but no significant difference was shown among the three groups. The WOMAC stiffness parameter was found to benefit from the treatment only in the first group, while the 10-m walk test improved for the first and third groups. The number of paracetamol tablets taken differed significantly neither in nor among the treatment groups. Conclusion: Previous trials have found a significant reduction in knee pain levels and an increase in function with IFC treatment, although there is no consensus on which carrier frequencies and duration to choose for IFC treatment. In this study, we detected significant benefits for all the different carrier frequency groups but were not able to show any to be superior to the others.

Introduction: This study was designed before the emergence of the COVID-19 pandemic, to assess the annual changes in muscle strength in relatively young Turkish people with postpolio syndrome (PPS). After we completed the baseline measurements, the COVID-19 pandemic emerged and lockdowns followed right after. Thus, the purpose of the study turned to how these lockdowns, which induced a sedentary lifestyle, have affected muscle strength in participants with PPS compared to healthy controls. Materials and Methods: This study included 49 hip joints (21 PPS vs. 28 healthy controls) and 51 knee joints (23 PPS vs. 28 healthy controls). Concentric isokinetic testing of bilateral hip and knee muscles was performed in all participants with PPS and controls just before the outbreak of the COVID-19 pandemic. The measurements were repeated after 1 year of lockdowns. Results: Perceived physical activities were reported to be decreased by 35.9% and 32.2% in participants with PPS and controls, respectively. No significant changes were observed in muscle strengths, and these changes did not differ between PPS and healthy controls. Conclusion: This is the first and possibly the only study to show that the muscle strengths of participants with PPS did not change significantly during 1 year of physical restraints due to the COVID-19 pandemic. These findings may support the basic principle in the rehabilitation of participants with PPS, which includes conserving energy and avoiding the overuse of muscles. However, more data from studies with a larger number of participants and longer follow-ups, which will hopefully never happen again in a situation like this, are required to draw a conclusion.

Objectives: This study aimed to evaluate the effects of the combined hydrolyzed type 2 collagen, methylsulfonylmethane (MSM), glucosamine sulfate (GS), and chondroitin sulfate (CS) supplement on knee pain intensity in patients with knee osteoarthritis (OA). Patients and methods: This multicenter, observational, noninterventional study included 98 patients (78 females, 20 males; mean age: 52.8±6.5 years; range, 40 to 64 years) who had Grade 1-3 knee OA between May 2022 and November 2022. The patients were prescribed the combination of hydrolyzed type 2 collagen, MSM, GS, and CS as a supplement for knee OA. The sachet form of the combined supplement containing 1250 mg hydrolyzed type 2 collagen, 750 mg MSM, 750 mg GS, and 400 mg CS was used once daily for two consecutive months. Patients were evaluated according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analog Scale (VAS)-pain, and Health Assessment Questionnaire (HAQ). Patients were scheduled to visit for follow-up four weeks (Visit 2) and eight weeks (Visit 3) after Visit 1 (baseline; day 0 of the study). Results: For the VAS-pain, WOMAC, WOMAC-subscale, and HAQ scores, the differences in improvement between the three visits were significant (p<0.001 for all). The patient compliance with the supplement was a median of 96.77%, both for Visit 2 and Visit 3. Conclusion: The combination of hydrolyzed type 2 collagen, MSM, GS, and CS for eight weeks in knee OA was considered an effective and safe nutritional supplement.

Background: In this prospective randomized trial, we aimed to study the effects of cardiac rehabilitation on functional capacity, depression and quality of life, in patiens undergone left ventricular assist device (LVAD) implantation for the treatment of heart failure. We also aimed to compare the effectiveness of home and hospital based exercise programs. Methods: 42 patients who had received LVAD implants in our university hospital were included in the study. After the subjects were randomized into hospital exercise group (n=20) and home exercise group (n=22). They were enrolled in a cardiac rehabilitation program for 8 weeks, which lasted for one hour, three times per week in hospital and at home respectively. All subjects were assessed at baseline and after the 8th week. Results: In our study we detected a significant improvement in peak oxygen expenditure (peak VO2), six minute walk test values and in Minnesota living with heart failure quentionnaire, state- trait anxiety inventory, state anxiety subscore in the hospital exercise group (p

Objective: Ankylosing spondylitis (AS) is a chronic inflammatory disease mainly affecting the vertebral column that is the prototype of the spondyloarthritides and is characterized by bone marrow edema, osteitis, erosions, enthesopathy, new bone formations and sclerosis. A decrease in bone mineral density (BMD), in addition to later restrictions in movement and muscle weakness, predisposes the patient to osteoporotic fractures. In this retrospective study, we aimed to assess the prevalence of osteoporosis (OP) and osteoporotic vertebral fractures. Materials and Methods: This study was conducted in Ege University Faculty of Medicine, Departments of Physical Medicine and Rehabilitation and Rheumatology on patients who were diagnosed with AS and who had in the previous year received a BMD examination. Demographic and disease information, Bath Ankylosing Spondylitis Disease Activity index scores and if present, findings of vertebral radiographs and vitamin D levels were recorded from patient files. These parameters were used to compare patients with or without OP. Results: One hundred consecutive patients that were seen in our outpatient clinic and who met the inclusion criteria were enrolled in this study. In BMD examinations, 48% of subjects were found to have OP or osteopenia. Sixty radiographs were reached and 16% of subjects were found to have at least one vertebral fracture. We detected a significant difference between these groups regarding age, sex, disease duration and BMD and T-scores at the levels of femur neck and total hip (p<0.05). We did not detect a significant correlation between clinical parameters and parameters related to OP (p>0.05). Conclusion: The presence of concomitant OP in patients with AS is significant for increased fracture risk, also recurrent vertebral fractures may exacerbate the spinal deformities caused by the disease itself. It bears importance that clinicians be aware of increased risk of OP to be able to better manage pain and function loss in this patient population.

Introduction: Hip fractures in older adults are associated with significant morbidity, mortality, loss of independence, and financial burdens. In this study, we assessed how factors influenced these effects in elderly patients presenting with hip fractures. Materials and Method: A prospective observational study was conducted over six months on all patients with fall and hip fractures above 50 years of age who presented to the orthopedics and traumatology clinic of our university hospital. Ambulation status, time until operation, vitamin D level, vertebral fractures, Charlson comorbidity index, and Fracture Risk Assessment Tool score were recorded. The patients’ re-evaluated in the sixth month after the fracture. The relationship between death and risk factors was examined by regression analysis. Results:105 patients were included in the study. The mortality rate was 23.8%. The immobility rate also increased from before the operation to after 1.9% to 31.4%. Univariate regression analysis showed that mortality is related to age, Charlson comorbidity index, smoking history, and Fracture Risk Assessment Tool hip score. At the same time, multivariate regression analysis revealed an association between body mass index, smoking history, and mortality. Conclusion :Osteoporosis is a widespread disease that may remain hidden until complications, such as fractures, present themselves. Functional loss and mortality risk are high in patients with fractures. Age, Charlson comorbidity index, body mass index, smoking, Fracture Risk Assessment Tool hip score, and pre-fracture ambulation status affect mortality. A decrease in mortality can be achieved by monitoring risky individuals in fracture liaison services. Keywords: Risk factors; Mortality; Osteoporosis; Hip fractures.

Purpose To investigate the prevalence of fibromyalgia(FM) and to show its relations with symptoms, polio-related impairments (PRI), and quality of life (QoL) in persons with prior paralytic poliomyelitis (PsPP) with and without post-polio syndrome (PPS). Materials and methods The study included 74 PsPP under 60 years of age, 60 of whom met the criteria for PPS. Presence and severity of FM were assessed by the American College of Rheumatology (ACR) 1990, 2010, and 2016 criteria, and Fibromyalgia Severity Score. PPS symptoms, PRI, and QoL were evaluated using the Self-Reported Impairments in Persons with Late Effects of Polio Rating Scale, Fatigue Severity Scale, and Nottingham Health Profile. Frequency, comparison, and correlation analyses were performed. Results While 15% of PsPP with PPS met the criteria of ACR 1990, 32% of ACR 2010, and 35% of ACR 2016, none of those without PPS met any of the criteria for FM. Severity of PPS symptoms and PRI were significantly higher, and QoL was significantly lower in those with co-existing FM. FM severity was found to be significantly associated with severity of PPS symptoms, PRI and reduced QoL. Conclusions FM frequently coexists in PsPP with PPS and may increase the burden of PPS.

Chronic pain and inflammation, loss of function, immobility and systemic involvement that are all characteristics of ankylosing spondylitis (AS) have been proposed to cause sleep problems. Almost 70-90% of patients with AS are reported to suffer from disturbed sleep. There are many indices that aim to assess quality and duration of sleep in clinical and academic settings. We have carried out a pilot study and enrolled 70 patients with AS and questioned each subject with a single question that assessed their quality of sleep. This question was taken from the 4th item of the Hamilton Anxiety scale and has been previously used in this population. We have asked patients to assess their sleep quality and score it from 0 to 4, 0 denoting no sleep disturbance and 4 denoting very severe sleep disturbance. The question was well understood and answered fast, causing no delay in routine patient care. Almost 90% of our patients reported some level of sleep disturbance. We have found a significant correlation between disease activity measured by Bath Ankylosing Spondylitis Disease Activity index and severity of sleep disturbance (p<0.05, r=0.34). Assessing quality of sleep in the routine clinical setting does not need to take a very long time and carries valuable information regarding patients’ physical and mental wellbeing.

Patients with ankylosing spondylitis (AS) are at an increased risk of osteoporosis (OP) and subsequent osteoporotic fractures due to bone fragility. Although AS is a risk factor for developing new-onset OP, there are no existing guidelines to routinely assess patients with AS for OP, and young men are less likely to be screened. Given that the underestimation of OP in patients with AS can have serious health consequences, a greater emphasis should be placed on this association. Major risk factors for vertebral fractures in AS include low bone mineral density (BMD) at the femoral neck and total hip (but not lumbar spine), male sex, longer disease duration, higher disease symptom scores, inflammatory bowel disease, and structural severity of the disease. The major pathophysiological mechanisms for osteoporosis appear to be systemic inflammation and low BMD resulting from decreased daily physical activity caused by pain, stiffness, and ankyloses. The weight of evidence is strongly in favor of the interleukin (IL)-17-IL-23 axis, tumor necrosis factor-alpha and gut immunopathobiology as central components affecting bone in AS.

Diagnosis of COVID19 is based on reverse transcription-polymerase chain reaction (RT-PCR) testing of nasopharyngeal swab (NPS) samples. As NPS sampling is a discomforting invasive procedure, studies were conducted to investigate the performance of saliva and mouthwash (MW) samples in RT-PCR. There is limited data about MW samples. We have developed a new method for concentrating gargle and mouthwash (GMW) samples to be used in RT-PCR. In our study, we aimed to investigate the performance of concentration of GMW samples in detection of SARS-CoV-2. A paired sample of NPS and GMW samples were collected from patients in 11 centers in Turkey. MW samples were concentrated using MyMagiCon-RW100® (Bio-T, Istanbul, Turkey). NPS, GMW and concentrated GMW samples were tested by RT-PCR for the presence of SARS-CoV2 and the results were compared. The viral RNA was detected in 47.5% of NPS samples, in 28.8% of GMW before concentration and in 37.5% GMW samples after concentration. Concentration of samples increased the number of samples in which SARS-CoV2 RNA was detected by 16.6%. The RT-PCR of concentrated GMW samples yielded better results than the RT-PCR of NPS samples in two centers. Concentrated GMW sampling can be an alternative method to NPS sampling in rapid and accurate diagnosis of COVID-19.

Traconia fish is a member of the Trichinidea family, all members are poisonous. In the literature, edema develops in the affected area after trachonia fish bite, followed by a wide spectrum of cases ranging from subcutaneous inflammation to myonecrosis. In this case report, we present a patient who was injured with the back spines of traconia fish and had limited edema and range of motion. The absence of pain in the joint restriction that developed over time and the normal bilateral hand radiography exclude us from the diagnosis of complex regional pain syndrome. The patient was treated with self-adherent wrap to reduce swelling in addition to soft tissue mobilization, range of motion exercises, and a contracture splint that forced metacarpophalangeal joints into flexion to increase joint mobility. We applied 15 sessions of treatment to the patient. On the post-rehabilitation examination, we found that the edema in the dorsum of the left hand decreased. We measured the range of motion of the patient as normal.

Molecular diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by real-time reverse transcription polymerase chain reaction (RT-PCR) in respiratory specimens is considered the gold standard method. This method is highly sensitive and specific but it has some limitations such as being expensive and requiring special laboratory equipment and skilled personnel. RapidFor™ Antigen Rapid Test Kit is a commercially available Ag-RDT which is produced in Turkey and designed to detect the nucleocapsid antigen of SARS-CoV-2 in nasopharyngeal swab samples. The aim of this study was to evaluate the performance of this novel SARS-CoV-2 antigen detection considering the RT-PCR method as the gold standard. Four hundred forty-four nasopharyngeal swab samples which were collected from the patients who met clinical criteria of COVID-19 from ten centers in Turkey between September 2020 and February 2021 were included in the study. All the nasopharyngeal swab samples were tested for SARS-CoV-2 RNA using commercial RT-PCR kits (Bioeksen and A1 Lifesciences, İstanbul, Turkey) according to the manufacturer’s instructions. Viral loads were assessed according to the cycle threshold (Ct) values. RapidFor™ SARS-CoV-2 antigen test (Vitrosens Biotechnology, Istanbul, Turkey) was used to investigate the presence of SARS-CoV-2 antigen in all samples following the manufacturer’s instructions. Out of 444 nasopharyngeal swab samples tested, 346 (77.9%) were positive and 98 (22.1%) were negative for SARS-CoV-2 RNA by RTPCR. Overall sensitivity of the RapidFor™. Antigen Rapid Test Kit was 80.3% whereas specificity was found to be 87.8%. Positivity rate of rapid antigen test in samples with Ct values over 25 and below 30 was 82.7%, while it increased to 95.7% in samples 20 ≤ Ct < 25 and reached 100% in samples with Ct values below 20. RapidFor™ SARS-CoV-2 Ag test might be a good choice in the screening of symptomatic and asymptomatic patients and their contacts for taking isolation measures early, with advantages over RT-PCR as being rapid, easy and being applicable in every laboratory and even at point of care.

While severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) continues to spread rapidly worldwide, some issues such as the uncertainty of the disease progress, whether intensive care will be needed, and risk classification are still important for clinicians. It is notable that in countries where latent tuberculosis infection (LTBI) is common and participating in the national Bacillus Calmette-Guerin (BCG) vaccination program, the case-fatality rates are relatively low throughout the world. In this study, it was aimed to evaluate the effects of the BCG vaccine and LTBI status on the course of the disease in patients diagnosed with coronavirus-19 (COVID-19) infection and to compare the LTBI rate with people with and without COVID-19 infection. The patients diagnosed with COVID-19 infection who were hospitalized during a period of seven months between May 1st to December 1st, 2020 were investigated by the QuantiFERON-TB Gold Plus (QFT-Plus) test in the blood samples for the presence of LTBI. For the comparison of the patients diagnosed with COVID-19 and people without COVID-19 infections in terms of LTBI rate retrospectively; all consecutive patients who were sent blood samples to the mycobacteriology laboratory for the QFT-Plus test between January 2016 and December 2019 were included in the study. Demographic, clinical, radiological, laboratory, and follow-up data of the patients were obtained from the electronic patient file. A total of 170 patients (n= 9 8 male [57.6%], n= 72 female [42.3%], mean age= 53.5 ± 15.8 years) were enrolled. Twenty-five patients' (25/170 [14.7%]) QFT-plus tests were positive. When the cases with positive QFT-Plus test (n= 25) and the cases with negative QFT-Plus test (n = 145) were compared in terms of disease severity respectively; it was determined that mild/moderate patients were 18/25 (72%) and 108/145 (74.5%), severe patients were 7/25 (28%) and 37/145 (25.5%) (p= 0.988). When these two groups were compared in terms of the clinical course respectively; the need for intensive care was 6/25 (24%) and 34/145 (23.4%) (p= 1.00), oxygen therapy requirement was 13/25 (52%) and 49/145 (33.8%) (p= 0.128), and death was 5/25 (20%) and 18/145 (12.4%) (p= 0.341). QFT-Plus positivity was 25/170 (14.7%) in patients diagnosed with COVID-19, while in control group it was 198/496 (39.9%) (OR= 0.259, 95% CI [0.164-0.411], p<0.001). When the values were evaluated quantitatively, in the COVID-19 patient group, QFT-Plus T1/T2 (IU/ml) interferon (IFN)-ɣ was 0.87 ± 1.52/0.62 ± 1.53, while in the control group it was 1.52 ± 3.69/1.50 ± 3.33 (p= 0.032, p= 0.04). There was no significant difference in the parameters investigated between 82 (48.2%) patients with BCG vaccine and those 88 (51.8%) without BCG vaccine. Although it was not statistically significant in our study, increased oxygen therapy requirement and higher mortality rates in the QFT-Plus positive group were remarkable. The detection of statistically significantly lower LTBI rates and T1-T2/IFN-ɣ values in the COVID-19 group supported that SARS-CoV-2 infection may suppress lymphocyte functions in patients and IFN-ɣ response. We believe that the results of our study are remarkably valuable, but more clinical studies are needed to elucidate the relationship between BCG vaccine, LTBI, and COVID-19 infection.

Cardiopulmonary exercise test (CPET) parameters are established prognosticators in heart failure. However, the prognostic value of preimplantation and postimplantation CPET parameters in left ventricular assist device (LVAD) therapy is unclear and it is evaluated in this study. Adult patients who were implanted with an LVAD and underwent CPET during the preimplantation or postimplantation period were retrospectively analyzed. Five CPET parameters were calculated: vO2 max, oxygen uptake efficiency slope (OUES), VE/vCO2 Slope, VE/vCO2 min, and VE/vCO2 max. The relationship between CPET parameters and postimplantation outcomes was evaluated with multivariable analysis. Pre and postimplantation CPET cohorts included 191 and 122 patients, respectively. Among preimplantation CPET parameters: vO2 max and OUES were associated with 1, 3, and 5 year mortality, VE/vCO2 min was associated with 3 and 5 year mortality, whereas VE/vCO2 Slope was associated with 5 year mortality. From postimplantation CPET parameters: vO2 max was an independent predictor of 3 and 5 year mortality, whereas VE/vCO2 max was an independent predictor of 3 year mortality following LVAD implantation. Preimplantation CPET parameters have a prognostic value for long-term survival following LVAD implantation, whereas their association with early postimplantation outcomes appears to be weaker. Postimplantation vO2 max and VE/vCO2 max values are associated with survival on device support and may provide a second chance for prognostication in patients without preimplantation CPET data.

Iliac wing osteonecrosis coexisting with sacral insufficiency fracture rarely causes low back pain. Radiotherapy (RT) applied to the pelvic area is an important precipitating factor. Here, we present a patient who was referred to our outpatient clinic with mechanical lower back pain that was present for 3 months. The patient had received RT to the pelvic region due to colorectal cancer. Contrast-enhanced magnetic resonance imaging studies revealed iliac wing osteonecrosis and sacral insufficiency fracture. After ruling out the possibility of metastasis and making a definitive diagnosis, the patient was followed-up and bed rest and calcium and vitamin D supplementations were recommended. Despite these precautions, the patient still developed another sacral insufficiency fracture. Mechanical low back pain has a myriad of etiologies and standard X-rays may underdiagnose rarer causes of pain, such as osteonecrosis and insufficiency fractures. Clinical suspicion of these entities, especially in patients with a history of RT, may help in diagnosis and treatment.