Afitap Icagasioglu

Bone mineral changes during pregnancy and lactation

Abstract Objective: Significant calcium transfer from the mother to the fetus and infant occurs during pregnancy and lactation, theoretically placing the mother at an increased risk for osteoporosis. The relationship between pregnancy, breast-feeding and low bone mass is controversial. In this study we aimed to elucidate the relationship between pregnancy, breast-feeding and bone mass in third trimester pregnants, at least 3 months lactating mothers, and healthy young nulliporous women by using quantitative ultrasonometry. Method: The study included 120 women divided in three groups: third trimester pregnants, at least 3 months lactating mothers and healthy young nulliporous women. Demographics, total lactation time, number of pregnancies, births and miscarriages-abortions were recorded. Study groups underwent quantitative ultrasonometry measurement at midtibial shaft. Values of the ultrasonometry variables were calculated and compared for groups. Results: There were no significant differences among the groups with respect to parameters of age, age at menarche, smoking, alcohol intake and physical exercise in all of the three groups (p > 0.05). No differences were found among the three groups in analyzed variables, when comparing SOS, T- and Z-scores mid-tibial shaft quantitative ultrasonometry. Conclusion: No statistically significant associations were found between ultrasonometry variables and pregnancy, breast-feeding or nulliparity.

A case of caudal regression syndrome: walking or sitting?

Caudal regression syndrome (CRS) is a congenital disorder which is seen vertebral anomalies in varying degrees from lower thoracic spineto the level of the coccyx. We present a case of CRS which is not intended operation for orthopedic deformities considering functionality. 2, 5 year-old girl referred to our clinic with complaints about walking disability, knee and foot deformities. Patients mother with unregulated diabetes did not have a history of drug use, radiation exposure and serious illness during pregnancy. Diagnosis had been put during antenatal follow-ups. On physical examination, her lower extremities were hypoplastic and had no muscle activity. Her hips were flexed and abducted, but did not have contractures. Her knees had 75 degrees of flexion contractures with popliteal webs and feet had equinovarus deformity. Frog belly was present due to abdominal muscles weakness. Also hypoplasic labia majora has been identified. In lumbar MRI, spinal cord was terminated at 6th thoracic (T6) vertebrae and the last solid vertebrae level was at T10. Patient who has been following by urology with clean intermittent catheterization had also severe urological problems including horseshoe kidney, neurologic bladder, vesico-ureteral reflux and grade 2 hydronephrosis. Orthopedic consultation was made for her deformities. They decided that ambulation unexpected patients knee flexion contractures were helping sitting balance. Because of this operation was not considered. Prognosis, treatment options, strength exercises for upper extremities, skin care were told to parents and patient was taken to follow. CRS is a rare congenital abnormality which is associated with orthopedic deformities, as well as urological, anorectal and cardiac malformations. Treatment requires a multidisciplinary approach. It should not be forgotten that purpose of rehabilitation is not to correct all deformities but increase the functionality of everyday life.

Pregabalin Treatment of a Patient With Complex Regional Pain Syndrome.

BACKGROUND Complex regional pain syndrome (CRPS) is a painful and disabling neurovascular condition. There is no consensus on the etiopathogenesis or the treatment. We present a patient with CRPS type 1 accompanied by a psychiatric disorder to discuss the relationship between CRPS and psychiatric disease and to emphasize the response of this case to treatment with pregabalin. PATIENT DESCRIPTION A 15-year-old girl presented with swelling, severe pain, edema, hyperesthesia, allodynia, and sweating changes in the left arm and was diagnosed as CRPS type 1. The presence of disturbed family relations was revealed on psychiatric examination, and a diagnosis of major depression was made. Her symptoms did not respond to selective serotonin reuptake inhibitors and noradrenergic and specific serotonergic antidepressives, gabapentin, or stellate ganglion blockage, but the patients pain resolved with pregabalin. Symptom-oriented measures and psychiatric support enabled ongoing treatment. A social services evaluation led to her being placed in the care of social services to protect her from the chaotic and traumatic family life. CONCLUSION Detailed psycological and psychiatric evaluation is recommended in individuals with CRPS because psychiatric support and improvement of associated psychosocial concerns in addition to pregabalin seems to facilitate treatments in some patients.

A preliminary study showing that ultrasonography cannot differentiate between psoriatic arthritis and nodal osteoarthritis based on enthesopathy scores

Author(s): Yumusakhuylu, Yasemin; Kasapoglu-Gunal, Esen; Murat, Sadiye; Kurum, Esra; Keskin, Havva; Icagasioglu, Afitap; McGonagle, Dennis; Zehra Aydin, Sibel

Relation of physical activity level with quality of life, sleep and depression in patients with knee osteoarthritis.

OBJECTIVE: In the present study, we aimed to investigate the effects of physical activity level on the quality of life, depression, sleep quality and functional capacity in elderly patients with knee osteoarthritis (OA). METHODS: Fifty-five patients over 65 years of age (age range: 65–84 years) with knee osteoarthritis were enrolled in the study. Patients were divided into two groups including Insufficient Activity Group (IAG) and Physically Active Group (PAG) according to their responses to the International Physical Activity Questionnaire. Radiological OA grading was performed using Kellgren-Lawrence classification system. Patients were evaluated using Short-Form 36 (SF-36) questionnaire, Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). RESULTS: Mean age, body mass indices, mean pain scores and gender distribution were comparable between the two groups. WOMAC physical function scores were lower in the Physically Active Group (p=0.01). Mean PSQI scores did not differ statistically significantly between the two groups (p=0.242). Mean BDI score of PAG was significantly lower compared to that of IAG (p=0.015). Mean SF-36 physical function (p=0.044), physical role (p=0.008) and physical component (p=0.016) scores of the Physically Active Group were significantly higher vs Insufficient Activity Group. CONCLUSION: Maintaining a high physical activity level reduces the possibility of depression and improves the quality of life and functional capacity in geriatric patients with knee osteoarthritis.

Musculoskeletal Pain and Quality of Life in Obese Patients

Abstract Objectives: The aim of this study is to investigate the impact of obesity on frequency and severity of musculoskeletal pain and quality of life. Methods: Demographic data of 230 patients that presented to the Physical Medicine and Rehabilitation Department because of musculoskeletal pain were acquired and analyzed. Patients were randomized into two groups according to body mass index [BMI] values: obese group [BMI ≥ 30 kg/m2] and normal-weighted group [BMI < 25 kg/m2]. Patients were asked for localization and duration of muskuloskeletal pain. Severity of pain was evaluated by using a visual analog scale. Information on difficulties of daily movements within the last month was obtained and quality of life was evaluated by using the Short-Form 36. Results: There was a statistically significant increase in frequency of neck pain [p = 0.049], shoulder pain [p = 0.001], elbow pain [p = 0.006], wrist and hand pain [p = 0.012], arm pain [p = 0.017], low back pain [p = 0.001], hip pain [p = 0.001], knee pain [p = 0.001], ankle-foot pain [p = 0.001], and leg pain [p = 0.001] in the obese group when compared with the normal-weighted group. There was a statistically significant increase in visual analog scale scores of the all body parts in the obese group when compared with in the normal-weighted group [p < 0.01]. There was a statistically significant difference between groups in difficulties of daily movements within last month [p < 0.01]. All the parameters of Short-Form 36 were found statistically significant lower in the obese group [p = 0.001]. Conclusions: Obesity is a multifactorial, chronic disease which causes many complications and pain on the musculoskeletal system. Difficulty of daily movements also decreases quality of life.

Inflammatory arthritis mimicking Complex Regional Pain Syndrome (CRPS) in a child: A case report.

Joint complaints in childhood are seen frequently and differential diagnosis can be difficult. Juvenile idiopathic arthritis (JIA) is the most common rheumatological disease of childhood. It involves peripheral joint arthritis, chronic synovitis, and extra-articular manifestations. Accurate diagnosis can take a long time and sometimes multiple diagnoses are used while following the patient until a final diagnosis can be reached. Arthritis may be triggered by trauma and confused with other diseases like complex regional pain syndrome (CRPS), in which trauma plays a role in the etiology. In the present case, ankle pain in an 8-year-old girl was misdiagnosed as CRPS.

FRI0437 Effects of ankylosing spondylitis on plantar pressure distribution

Background It is considered that postural changes that occur in patients with ankylosing spondylitis (AS) are biomechanically compensated for by contribution from movements of hip, knee and ankle joints [1]. The effects of this phenomenon on the foot, the most distal segment of the kinetic chain, have not been fully elucidated. Objectives In the present study, our aim was to investigate possible changes in plantar load distribution in AS patients. Methods The study enrolled 30 AS patients diagnosed as per modified New York criteria and 30 healthy controls matched for age, gender and body mass index. Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) scores were obtained for all patients. Using a foot pressure platform, the distance from the center of pressure (CoP) to the posterior heel line was measured in centimeters (cm) in both groups (DCoP) (figure 1). Percent total plantar load distribution over the proximal half and distal half of the foot was calculated. Results Mean DCoP distance was significantly shorter in AS patients 9.65±0.96 cm) in comparison to that of control group (10.41±0.89 cm) (p=0.011). While the percent total plantar pressure applied on proximal half of the foot was 60.46±7.62% in AS patients, it was only 55.95±6.21% in the control group (p=0.031). However, AS patients had less percent pressure applied on the distal half of the foot (39.53±7.62%) versus control patients (44.04±6.21%) (p=0.031). The mean ratio of the percent pressure distribution over the proximal half of the foot to the percent pressure distribution over the distal half of the foot was significantly greater in AS patients (1.64±0.62) compared to control group (1.31±0.35) (p=0.037). Conclusions Plantar pressure distribution seems to be displaced towards the heel in the sagittal plane due to biomechanical changes in patients with ankylosing spondylitis. This points out to the significance of the lower extremities in the compensation of postural changes in AS patients. References Murray HC, Elliott C, Barton SE, Murray A: Do patients with ankylosing spondylitis have poorer balance than normal subjects? Rheumatology 2000, 39:497–500. Disclosure of Interest None declared

Back Pain from Spinal Tuberculosis

Abstract Background: Spinal tuberculosis is an uncommon disease but still occurs widely. Findings: We describe a 56-year-old woman presenting with a severe backache. She was diagnosed with osteoporosis and a lumbar disc herniation two months ago, but tuberculosis had not been diagnosed before. We reviewed the relevant literature and emphasized the impact of early diagnosis of spinal tuberculosis. Conclusions: The onset of tuberculous spondylitis is insidious in nature, with various clinical presentations. Lack of specific symptoms causes delays in diagnosis. Its diagnosis may be delayed because tuberculosis is not considered in the differential diagnosis. In cases with severe back pain, spinal tuberculosis must be included in the differential diagnosis.