Ayşe Dicle Turhanoğlu

Polypharmacy in the elderly: a multicenter study.

OBJECTIVE The aim of this study was to evaluate the polypharmacy issue and its correlations with socioeconomic variables in Turkish elderly patients. DESIGN Cross-sectional SETTING Outpatient clinics of the medical schools, departments of physical medicine and rehabilitation from 12 provinces. PARTICIPANTS A total of 1430 elderly in different geographical regions of Turkey during January 2007 to January 2008 were included. MEASUREMENTS Patients were interviewed using a questionnaire that included demographic characteristics, current medical diagnosis, and pharmaceuticals that are used by elderly. Demographical parameters were gender, age, marital status, number of children, level of education, province, and status of retirement. RESULTS The mean number of drugs was found to be higher in the females. There was a significant difference among age groups, marital status groups, and the number of children categories. The distribution of the number of drugs among education levels did not differ significantly, whereas the distribution of the number of drugs between the status of retirement and presence of chronic disease differed significantly. CONCLUSIONS Polypharmacy is correlated with various factors including age, sex, marital status, number of children, status of retirement, and presence of chronic medical conditions but not educational status in our study group.

Ultrasound-guided vs. blind steroid injections in carpal tunnel syndrome: A single-blind randomized prospective study.

ObjectiveThe aim of this study was to compare the efficacy and the safety of ultrasound (US)–guided vs. blind steroid injections in patients with carpal tunnel syndrome (CTS). DesignThis prospective randomized single-blind clinical trial included 46 patients with CTS (46 affected median nerves). The subjects were randomized—to either the US-guided or the blind injection group—before they received 40 mg of methylprednisolone. They were evaluated using the Boston Carpal Tunnel Questionnaire symptom/function at baseline and at 6 wks and 12 wks after injection, and the side effects were noted. ResultsThe symptom severity and functional status scores improved significantly in both groups at 6 wks after treatment, and these improvements persisted at 12 wks after treatment (all P < 0.05). The improvement in symptom severity scores in the US-guided group at 12 wks was higher than in the palpation-guided group (P < 0.05). Average time to symptom relief was shorter in the US-guided group (P < 0.05). There was no significant difference between the two groups in terms of side effects (P > 0.05). ConclusionsAlthough both US-guided and blind steroid injections were effective in reducing the symptoms of CTS and improving the function, an earlier onset/better improvement of symptom relief suggests that US-guided steroid injection may be more effective than are blind injections in CTS.

The epidemiological aspects of irritable bowel syndrome in Southeastern Anatolia: a stratified randomised community‐based study

Even though studies on the epidemiology of the irritable bowel syndrome (IBS) are increasing day by day, epidemiological data are still unknown in many regions. Our objective was to determine the IBS prevalence, factors associated with this prevalence and probable risk groups in Southeastern Anatolia.

Effect of coexisting foot deformity on disability in women with knee osteoarthritis.

BACKGROUND Knee osteoarthritis, a common musculoskeletal disorder, can cause considerable pain and disability. This study investigates the effect of certain foot deformities on the functional status of women with knee osteoarthritis. METHODS The common foot deformities pes planus and hallux valgus were evaluated in 115 women with knee osteoarthritis and Kellgren-Lawrence grade 2 and 3 osteoarthritis. Anteroposterior and lateral foot-ankle standard radiographs were obtained bilaterally. A lateral talometatarsal angle greater than 4 degrees was defined as pes planus. A hallux valgus angle greater than 21 degrees was defined as hallux valgus. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to objectively assess functional impairment. Knee pain intensity was measured with a visual analog scale. RESULTS Fifty-nine patients had bilateral pes planus, hallux valgus, or both. The mean visual analog scale value was higher for the deformity group, but the difference was not statistically significant. There was a significant difference in WOMAC scores between the group with foot deformities versus the group without (P = .000). Visual analog scale scores were positively correlated with WOMAC scores (r = 0.499, P = .000). Also, there was a significant correlation between WOMAC scores and lateral talometatarsal angle (r = 0.266, P = .004) and hallux valgus angle (r = 0.362, P = .000) values. CONCLUSIONS There is a significant correlation between indicators of pain and disability (visual analog scale and WOMAC scores). Also, the presence of foot deformities increased disability levels in women with knee osteoarthritis.

The Epidemiological Aspects of Fibromyalgia Syndrome in Adults Living in Turkey: A Population Based Study

Objective: The objectives of this study were to determine the prevalence of the fibromyalgia syndrome [FMS] in Diyarbakır, a city located in the southeastern region of Turkey, and to evaluate associated demographic variables. Methods: This study was conducted in the beginning of 2003. A total of 600 people, randomly selected by stratified cluster sampling, were interviewed in person using a questionnaire consisting of demographic features and history of chronic widespread pain. Individuals with chronic widespread pain were examined by a specialist in physical medicine and rehabilitation in order to confirm or exclude FMS based on the American College of Rheumatology classification criteria. The statistical analysis was performed by using a package program called Epi Info 2000. Results: Fifty-three people were diagnosed with FMS. Based on the study results, the prevalence of FMS was 8.8 percent in our regional study group. The prevalence was higher in women [12.5 percent] than in men [5.1 percent; P = 0.002, OR = 3.038, 95% CI = 1.5–6.1], and subjects in urban areas [11.4 percent] had a higher FMS rate than subjects in rural areas [5.2 percent; P = 0.011, OR = 2.388, 95% CI = 1.2–4.6]. The FMS was most common in the 50- to 59-year-old age group. No difference was observed in terms of education, occupation, and marital status. Conclusion: To the best of our knowledge, this cross-sectional study is the first report on the prevalence of FMS in Diyarbakır. The FMS prevalence was 8.8 percent in our region. The FMS was found 2.45 times more common in women than in men and found 2.3 times higher in urban areas than in rural areas.

Reaction time and movement time in patients with carpal tunnel syndrome: an electromyographic study

OBJECTIVE To measure the motor performance of the flexor pollicis brevis, first dorsal interosseus, and flexor pollicis longus muscles using the parameters electromyographic muscle reaction time and movement time in patients with carpal tunnel syndrome during key turning function. METHOD A total of 37 female patients with right hand pain were divided into two groups: 21 with an electrophysiologically confirmed diagnosis of carpal tunnel syndrome (Group I), and 16 with normal electrophysiological findings (Group II). The reaction time and movement time values obtained by surface electromyography of the right flexor pollicis brevis, first dorsal interosseus, and flexor pollicis longus muscles were compared between groups. RESULTS Of the 21 patients in Group I, 15 had mild, four moderate, and two severe median nerve lesions. No significant difference between groups was found in the electromyographic reaction time and movement time values of the right flexor pollicis brevis, first dorsal interosseus, and flexor pollicis longus muscles during key turning (P>0.05). There was also no significant difference in electromyographic reaction time and movement time between six patients with severe or moderate carpal tunnel syndrome and 15 patients with mild carpal tunnel syndrome in Group I (P>0.05). Sixteen patients in Group II did not have carpal tunnel syndrome. CONCLUSION The results indicate that patients with and without carpal tunnel syndrome have similar values of reaction time and movement time of the flexor pollicis brevis, first dorsal interosseus, and flexor pollicis longus muscles during the pinch grasp function of the hand. RELEVANCE Muscle reaction time and movement time, and hence the motor performance in electrophysiologically confirmed carpal tunnel syndrome patients appear to have similar parameters in patients with hand pain whose diagnosis were not confirmed with electrophysiologically.

Abdominal Aortic Aneurysm as a Long Time Cause of Low Back Pain and Vertebral Scalloping

Dear Editor, A 47-year-old male smoker was referred to our outpatient clinic with slowly developing, continuous low back pain (LBP) and vascular claudiation in his lower extremities. LBP had persisted for 6 years. His back pain was insidious at onset, and the pain worsened with standing and walking. His complaints sometimes occurred even at rest, especially during lying down. He did not have any other signs of cardiovascular distress other than the fatigue. He has never sought help for his back pain. He reported no history of regular exercise. He had no history of major trauma. Medical history revealed hypertension. On physical examination, the neuro-muscular examination was normal. Arterial …

Association of Vitamin D with Disease Activity in Rheumatoid Arthritis and Ankylosing Spondylitis

1 Abdullah Erman Yagiz1, Nilgun Ustun1, Hacer Paksoy1, Ihsan Ustun2, Ayhan Mansuroglu3, Hayal Guler1, Ayse Dicle Turhanoglu1 1Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Mustafa Kemal University, 2Department of Internal Medicine, Faculty of Medicine, Mustafa Kemal University, 3Clinic of Physical Medicine and Rehabilitation, Antakya State Hospital, Hatay, Turkey Vitamin D ve Hastalık Aktivitesi / Vitamin D and Disease Activity Association of Vitamin D with Disease Activity in Rheumatoid Arthritis and Ankylosing Spondylitis

Ultrasound diagnosis of the phalanx fracture not designated by plain radiographs.

A 19-year-old man was evaluated due to pain in his left index finger. Medical history yielded a roller press injury to his left hand three weeks previously. Physical examination revealed pain with the palpation and motions of the second proximal phalanx, swelling and normal range of motion. Plain radiographs were not remarkable (fig 1A,B). Longitudinal and axial ultrasound (US) images clearly designated cortical collapse at the dorsal surface of the proximal phalanx (fig 1C,D) compared with the other side (Fig 1E,F). Overall, the patient was diagnosed with non-displaced stable fracture of the proximal phalanx and he was treated with static splinting for three weeks. As a rule plain radiographs are the initial imaging modality for the visualization of bone injuries [1,2]. Nonetheless, in case of high clinical suspicion – if the plain radiographs are normal –, advanced imaging modalities are usually required. Computed tomography and magnetic resonance imaging (MRI) are also utilized to provide a better evaluation of the fracture for optimal treatment planning when a more detailed evaluation of the fracture is needed. For instance MRI should be performed to provide the precise diagnosis of stress fractures in cases with normal radiographs [1]. On the other hand, US has become widely used and has increasingly gained importance for the injuries of the musculoskeletal system with several advantages (lack of ionizing radiation, patient friendly, ease of application, repeatable, cheaper than MRI and computed tomography, non-invasive, provides multi-planar and dynamic imaging). Likewise, US is very likely to detect cortical lesions of the bone [3]. Accordingly, we suggest that US is a convenient imaging modality to visualize bone injuries for the initial evaluation if the plain radiographs are normal or not available.