Ali Yavuz Karahan

Axis I and Axis II psychiatric disorders in patients with fibromyalgia

OBJECTIVE To determine the current prevalence of Axis I and Axis II psychiatric disorders in patients with fibromyalgia. METHOD The study sample includes 103 patients with fibromyalgia and 83 control subjects. Axis I and Axis II disorders were determined by structured clinical interviews. RESULTS The rate of any Axis I psychiatric disorder (47.6% vs. 15.7%), major depression (14.6% vs. 4.8%), specific phobia (13.6% vs. 4.8%), any Axis II disorder (31.1% vs. 13.3%), obsessive-compulsive (23.3% vs. 3.6%) and avoidant (10.7% vs. 2.4%) personality disorders were significantly more common in the patient group compared to the control group. CONCLUSION Our results suggest that a considerable proportion of patients with fibromyalgia also present with Axis I and Axis II psychopathologies.

FAMILIAL MEDITERRANEAN FEVER

Familial Mediterranean Fever is an autosomal recessive inherited disease with a course of autoinflammation, which is characterized by the episodes of fever and serositis. It affects the populations from Mediterranean basin. Genetic mutation of the disease is on MEFV gene located on short arm of Chromosome 16. The disease is diagnosed based on clinical evaluation. Amyloidosis is the most important complication. The only agent that decreases the development of amyloidosis and the frequency and severity of the episodes is colchicine, which has been used for about 40 years. In this review, we aimed to discuss especially the most recent advances about Familial Mediterranean Fever which is commonly seen in our population.

Efficacy of therapeutic ultrasound in the treatment of spasticity: A randomized controlled study

The purpose of this study was to investigate the effect of ultrasound (US) on the spasticity occurring in the ankle plantar flexor muscles after a cerebrovascular event. According to the modified Ashworth scale (MAS), the hemiplegic patients with stage 2-3 spasticity on the ankle plantar flexor muscles were enrolled in the study and divided into two groups. Passive stretching exercise was applied to both groups. Additionally, 10-minute US was applied to one of the groups, using the mode of continuous wave of 1.5w/cm^{2} to the calf muscles before stretching. In order to monitor the efficacy of the treatment in the patients, MAS, Hmax/Mmax ratio, the ankle range of motion (ROM), Functional Independence Measure and Brunnstrom Motor Recovery Stage were evaluated. While a significant recovery was monitored in the MAS and ankle ROM measurements after treatment in both groups, no change was obtained in the other parameters. No significant difference was detected in any of the measurements between the groups. In this study, US treatment applied in combination with the ankle plantar flexor muscles passive stretching exercise was determined to have no effect on the stretching treatment in minimizing the spasticity.

A Multicenter Study of 1144 Patients with Cerebral Venous Thrombosis: The VENOST Study

BACKGROUND Based on a number of small observational studies, cerebral venous sinus thrombosis has diverse clinical and imaging features, risk factors, and variable outcome. In a large, multicenter cerebral venous thrombosis (VENOST) study, we sought to more precisely characterize the clinical characteristics of Caucasian patients. METHODS All data for the VENOST study were collected between the years 2000 and 2015 from the clinical follow-up files. Clinical and radiological characteristics, risk factors, and outcomes were compared in terms of age and sex distribution. RESULTS Among 1144 patients 68% were women, and in older age group (>50 years) male patients were more prevalent (16.6% versus 27.8%). The most frequent symptoms were headache (89.4%) and visual field defects (28.9%) in men, and headache (86.1%) and epileptic seizures (26.8%) in women. Gynecological factors comprised the largest group in women, in particular puerperium (18.3%). Prothrombotic conditions (26.4%), mainly methylenetetrahydrofolate reductase mutation (6.3%) and Factor V Leiden mutation (5.1%), were the most common etiologies in both genders. 8.1% of patients had infection-associated and 5.2% had malignancy-related etiology that was significantly higher in men and older age group. Parenchymal involvement constitutively hemorrhagic infarcts, malignancy, and older age was associated with higher Rankin score. Epileptic seizures had no effect on prognosis. CONCLUSIONS Clinical and radiological findings were consistent with previous larger studies but predisposing factors were different with a higher incidence of puerperium. Oral contraceptive use was not a prevalent risk factor in our cohort. Malignancy, older age, and hemorrhagic infarcts had worse outcome.

Comparison among pain, depression, and quality of life in cases with failed back surgery syndrome and non-specific chronic back pain

[Purpose] The aim of this study is to compare patients with failed back surgery syndrome (FBSS) with those with non-specific chronic back pain (NSCBP) in terms of pain, depression, and quality of life levels to explain the effects of surgery experience on low-back pain. [Subjects and Methods] A total of 50 patients with FBSS and 51 patients with NSCBP who consecutively applied to the outpatient clinic from September 2012 to April 2013 were included in the study. Patients completed questionnaires on demographics, body mass index, education level, work history, and pain duration (in months). Lumbar pain at rest, during movement, and at night were measured with a visual analogue scale (VAS). The Short Form 36 scale was used for evaluating quality of life, and the Beck Depression Inventory (BDI) was used for assessing depression. [Results] VAS scores reporting pain at rest and at night and BDI scores were significantly higher in the FBSS group than in the NSCBP group. Role limitations due to physical functioning, which is one of the measures of quality of life, were significantly higher in the FBSS group than in the NSCBP group. [Conclusion] These assessments show that surgery experience in patients with ongoing low-back pain makes their pain and depression worse.

Comparison of effectiveness of different exercise programs in treatment of failed back surgery syndrome: A randomized controlled trial.

BACKGROUND Failed back surgery syndrome (FBSS) is a condition characterized by persistent pain following back surgeries. OBJECTIVE To determine the effects of different exercises programs in FBSS. METHODS A Single-blind, randomized, controlled trial designed. One hundred participants with failed back surgery syndrome were randomly assigned to three different exercises groups (Isokinetic, Dynamic lumbar stabilization (DLS), and home exercises (HE) groups) and a control group. Patients were evaluated before and after 8-week exercise program and follow-ups at the 3rd and 6th months after the exercise program. Finger-floor distance and lumbar Schober for lumbar mobility, visual analog scale (VAS) for pain, modified Oswestry disability index, Beck depression inventory, fear-avoidance attitudes survey, and progressive-isoinertial weight lifting test were used as follow-up parameters. Lumbar muscle strength was assessed with the isokinetic dynamometer. RESULTS VAS levels were decreased from 67.7 to 22.8 in isokinetic and from 68.7 to 25.0 in DLS and from 64.6 to 47.1 in HE groups at the end of the program (p< 0.05). Also, all of other follow-up parameters of the isokinetic and DLS exercise groups viewed significant improvements compared to the control group. CONCLUSIONS According to our results either isokinetic or DLS exercises are more effective in FBSS patients.

An important cause of pes planus: the posterior tibial tendon dysfunction

Posterior tibial tendon dysfunction (PTTD) is an important cause of acquired pes planus that frequently observed in adults. Factors that play a role in the development of PTTD such as age-related tendon degeneration, inflammatory arthritis, hypertension, diabetes mellitus, obesity, peritendinous injections and more rarely acute traumatic rupture of the tendon. PTT is the primary dynamic stabilizer of medial arch of the foot. Plantar flexion and inversion of the foot occurs with contraction of tibialis posterior tendon, and arch of the foot becomes elaveted while midtarsal joints are locked and midfoot-hindfoot sets as rigid. Thus, during the walk gastrocnemius muscle works more efficiently. If the PTT does not work in the order, other foot ligaments and joint capsule would be increasingly weak and than pes planus occurs. We present a 10-year-old female patient diagnosed as PTTD and conservative treatment with review of the current literature.

Neutrophil-to-lymphocyte ratio is involved in the severity of ankylosing spondylitis.

OBJECTIVE Ankylosing spondylitis (AS) is a progressive chronic inflammatory disease mainly characterized by axial skeleton and sacroiliac joint involvement. We aimed to investigate the relation between neutrophil-to-lymphocyte ratio (NLR) and disease severity of AS and to explore its availability in clinical practice. METHODS A total of 102 AS patients and 60 individuals who were age- and gender-compatible with the control group were included into the study. Patients were divided into 2 groups according to Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores. Patients with BASDAI scores < 4 were considered to be having mild disease activity, whereas those with scores ≥ 4 were considered to be displaying severe disease activity. Hemogram test during the diagnosis, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) and other laboratory values of the control group were recorded. RESULTS NLR was observed to be higher in AS patients compared to the controls (2.47 ± 1.33 and 1.72 ± 0.47; respectively; p<0.0001). NLR was observed to be significantly higher in severe AS disease activity compared to the mild AS disease activity (2.72 ± 1.41, 2.20 ± 1.19; respectively; p = 0.001). NLR had statistical significant differences between mild disease activity compared to the controls (2.20 ± 1.19 and 1.72 ± 0.47, respectively; p = 0.263). There was a positive correlation between NLR and BASDAI (r = 0.193, p = 0.041). The performance of NLR evaluating the disease severity by Roc analysis had sensitivity of 69%, specificity of 54% (cut-off value 1.91), and AUC of 0.652 (95% Cl, 0.549-0.755) (p = 0.006). CONCLUSIONS NLR may be a simple and inexpensive marker to indicate disease activity in patients with AS in daily clinical practice (Tab. 3, Fig. 3, Ref. 25).

Diagnostic Performance of Superb Microvascular Imaging and Other Sonographic Modalities in the Assessment of Lateral Epicondylosis

The aim of this study was to compare the diagnostic performance of different sonographic modalities for diagnosing lateral epicondylosis.

Extracorporeal shock wave therapy versus corticosteroid injection in the treatment of trigger finger: a randomized controlled study.

The purpose of this study was to compare the efficacies of extracorporeal shock wave therapy and corticosteroid injection for the management of trigger finger. In this prospective randomized clinical trial, 40 patients with actively correctable trigger fingers were randomly assigned to extracorporeal shock wave therapy (1000 impulses and 2.1 bar) or injection groups. The effectiveness of the treatment was assessed using cure rates, a visual analogue scale, the frequency of triggering, the severity of triggering, the functional impact of triggering, and the Quick-Disabilities of the Arm, Shoulder, and Hand questionnaire at 1, 3, and 6 months after treatment. An intention-to- treat analysis was used in this study. Both groups demonstrated statistically significant improvements in all outcome measures after treatment. The intention-to-treat analyses showed no between-group differences for cure rates, pain, and functional status at follow-up. We conclude that extracorporeal shock wave therapy could be a non-invasive option for treating trigger finger, especially for those patients who wish to avoid steroid injections. Level of evidence: Level II.