Ebru Umay

The relationship between bisphosphonate use and demographic characteristics of male osteoporosis patients

INTRODUCTİON: This study aimed to investigate a number of demographic characteristics in males with osteoporosis (OP) treated with bisphosphonate and determine whether any of these measures could act as an effective indicator of medication persistence and compliance. MATERIAL AND METHOD: Among the patients with OP who applied to our clinic and were prescribed weekly oral bisphosphonate treatment, 89 patients over 50 years of age were included in this study. The demographic characteristics of these patients were evaluated. The number of medications used by the patients over the past 1 and 3 years were counted, and the persistence and compliance with bisphosphonate treatment was estimated. The patients were divided into two groups: fully compliant and noncompliant subjects. The two groups of patients were compared separately for 1 and 3 years while considering their demographic characteristics. RESULTS: The mean age of the 89 patients included in the study was 62.43±9.41 years. Comparisons among the studied demographic characteristics during the 1-year period of medication use indicated that the educational status of the fully compliant patients was higher. During the 3-year period of medication use, educational status was the only demographic characteristic that was determined to be significantly lower in the noncompliant patients than in the fully compliant group. CONCLUSION: Although deficiencies in medication persistence and compliance during osteoporosis treatment can lead to serious health and social problems in both genders, the causes of these deficiencies have not been thoroughly clarified. We suggest that the educational status of the patient may contribute to these deficiencies.

Poststroke depression: risk factors and potential effects on functional recovery

The factors that may cause poststroke depression were investigated in the literature focusing on lesion localization, age, stroke severity, and impairments in physical and cognitive function. The aim of this study was to examine the risk factors influencing the development of poststroke depression and to determine the effect of depression on the patients’ functional improvement after rehabilitation. Patients in the first 6-month period after stroke who were hospitalized in the Physical Medicine and Rehabilitation Clinic were included in this study. Patients who were admitted to the hospital within 0–30 and 30–120 days from the date of stroke were considered early and late rehabilitation entrants, respectively. The sample of this study included 93 patients. Patients’ demographic and clinical characteristics, complications, and medical history were recorded. Upper extremity motor function, ambulation, and mood were evaluated according to the Frenchay Arm Test, the Functional Ambulation Scale, and the Beck Depression Inventory, respectively. The Functional Independence Measure (FIM) was applied to patients at admission to the hospital, at discharge, and 1 month after discharge (follow-up). The mean age of the patients was 58 years and the mean disease duration was 53 days. Depression was diagnosed in 49 (53%) patients. Except for age and disease duration, none of the factors of sex, hemiplegic side, stroke severity, stroke etiology, neglect, spasticity, sedentary lifestyle, poststroke immobility, and early-onset or late-onset to rehabilitation was found to induce statistically significant differences in the development of depression. Statistically significant changes occurred in total FIM levels between the groups with and without depression between admission and discharge, admission and follow-up, and discharge and follow-up. The levels were significantly higher in patients without depression than in patients with depression. Depression was found in a high frequency in stroke patients. Younger age and long disease duration were found to be factors affecting the development of depression. FIM scores were observed to be lower in stroke patients with depression.

Reliability and validity study of a Turkish version of the fatigue severity scale in Parkinson’s disease patients

The aim of this study was to assess the validity and reliability of the Turkish version of the Fatigue Severity Scale (FSS) in Parkinson’s disease (PD) patients for use in clinical settings. A consecutive 106 patients with PD were included in the study. The Turkish version of FSS was analyzed for reliability (internal consistency and reproducibility) and validity (convergent and discriminant). The Turkish version of FSS yielded an acceptable internal consistency (Cronbach’s &agr;=0.960 and corrected item-total correlations: 0.761–0.891), and it was established as reproducible (test–retest intraclass correlations for items: 0.887–0.936). The FSS total score was correlated significantly with PD-related variables. Between-group differences on both items and the total score of FSS by modified Hoehn and Yahr staging were found to be statistically significant. The present study has shown that the Turkish version of the FSS is a valid and reliable tool for the assessment of fatigue in PD patients.

Importância do período de silêncio cutâneo na fibromialgia e sua relação com as características da doença, distúrbios psicológicos e qualidade de vida dos pacientes

INTRODUCTION: Cutaneous silent period (CSP) is an inhibitory spinal protective reflex and its afferents consist of A-delta nerve fibers. We aimed to evaluate patients with fibromyalgia (FM) and healthy controls to determine any differences between the groups in terms of CSP duration and latency, and if present, to determine whether there is any relationship with disease characteristics, psychological disorders and quality of life. MATERIALS AND METHODS: Thirty-two patients with FM and 32 healthy volunteers were included in the study. The patient and control groups were compared in terms of CSP latency and duration in both upper and lower extremities. Disease characteristics, psychological disorders and quality of life of patients were assessed using the Fibromyalgia Impact Questionnaire (FIQ) and Short Form-36 (SF-36). Patients with CSP measurements equal to or lower than those of the control group were compared with those with higher values than controls in terms of disease characteristics, psychological status and quality of life. RESULTS: Significantly prolonged CSP latencies in both upper and lower extremities were determined in patients compared to controls. We found that prolongation of CSP latency in the lower extremity is associated with disease severity and functional disability. CONCLUSIONS: CSP latencies in both upper and lower extremities in patients with FM are longer than in healthy volunteers. Moreover, prolongation of CSP latency in the lower extremity is associated with disease severity and physical functional disability.

Botulinum toxin injection of the subscapularis muscle

Patients with hemiplegia frequently suffer from pain and have a limited range of motion (ROM) of the shoulder. The common pattern of shoulder movement in a patient with spastic hemiplegia is primarily adduction and internal rotation. Spasticity of the subscapularis muscle limits the abduction, external rotation and flexion of the shoulder. Injection of botulinum toxin or application of phenol can reduce the spasticity of the subscapularis muscle and various techniques to inject this muscle have been reported. We injected five patients with hemiplegia with botulinum toxin using our previously reported inferior approach, which is easy, safe and effective. We observed a reduction in pain and spasticity and improvement in the ROM of the shoulder for all patients.

Sensory disturbance and polyneuropathy in rheumatoid arthritis patients with foot deformity

INTRODUCTION Our aim in this study was to present the results of sensory evaluation tests and electrophysiological evaluations in rheumatoid arthritis (RA) patients with foot deformity and to determine their relation with general health status and lower extremity functionality. MATERIALS AND METHODS Fifty-one patients with RA diagnosis and foot deformity were included in the study. Demographic and disease characteristics of the patients were recorded, and a detailed neurological examination was performed. Superficial sensation, pain, heat, vibration, and two-point discrimination sensation were evaluated in each foot, and their sum was used to determine the sensory deficits index (SDI) of 0-10. The presence of polyneuropathy was evaluated with electrophysiological methods. The Health Assessment Questionnaire and mobility and walking subscales of the Arthritis Impact Measurement Scales-2 were used to assess general health status and lower extremity functionality, respectively. According to the sensory examination and electromyography results, patients were compared in terms of their general health status and lower extremity functional status. RESULTS Sensory disturbance was detected in 39 patients (74%) during the examination; however, 27 patients (52.9%) had polyneuropathy determined electrophysiologically. In patients with sensory deficits, statistically significant deterioration was detected in general health and foot functionality, including mobility and walking, when compared to patients with a normal sensory evaluation. CONCLUSIONS Even in the presence of normal electrophysiological tests, sensory dysfunction alone seems to be associated with severe disability in general health status and foot functionality when compared to patients with a normal sensory examination.

The Role of Electrophysiologic Evaluation in Dysphagia Diagnosis in Acute Stroke Patients

Background and Purpose: It was aimed at investigating the efficiency of electrophysiological evaluation procedure by compared to healthy controls in acute period stroke patients in this study. As a secondary aim, it was evaluated that whether the patient groups defined as “dysphagic” and “with normal swallowing” were different from each other or not, in respect to the stroke severity and disability. Methods: Forty-two stroke patients and 15 healthy hospital personnel were included in this study. Demographic and disease characteristics of patients were recorded. The stroke severity and disability rate were evaluated. Electrophysiological evaluation was performed in all participants. Electro neuromyography recordings were received from submental electrodes and laringeal sensor. Swallowing interval times and dysphagia limit were recorded. Patient and control groups were compared in terms of electrophysiologic evaluation method. The patient group separated in itself as “normal swallowing” and “patients with dysphagia” according to the interval times and dysphagia limit and were compared in terms of stroke severity and disability rate. Results: The all interval times in the patient group were found significantly longer than the control group. The stroke severity and the disability of the patients defined as “with dysphagia” were found significantly higher than the “normal swallowing” patients, in term of the pharyngeal phase time. Conclusions: The electrophysiologic evaluation the swallowing phase times is a sensitive and objective method in acute period stroke patients that can drink liquid in normal quantities, especially.

Importance of cutaneous silent period in fibromyalgia and its relationship with disease characteristics, psychological disorders and quality of life of patients

INTRODUCTION Cutaneous silent period (CSP) is an inhibitory spinal protective reflex and its afferents consist of A-delta nerve fibers. We aimed to evaluate patients with fibromyalgia (FM) and healthy controls to determine any differences between the groups in terms of CSP duration and latency, and if present, to determine whether there is any relationship with disease characteristics, psychological disorders and quality of life. MATERIALS AND METHODS Thirty-two patients with FM and 32 healthy volunteers were included in the study. The patient and control groups were compared in terms of CSP latency and duration in both upper and lower extremities. Disease characteristics, psychological disorders and quality of life of patients were assessed using the Fibromyalgia Impact Questionnaire (FIQ) and Short Form-36 (SF-36). Patients with CSP measurements equal to or lower than those of the control group were compared with those with higher values than controls in terms of disease characteristics, psychological status and quality of life. RESULTS Significantly prolonged CSP latencies in both upper and lower extremities were determined in patients compared to controls. We found that prolongation of CSP latency in the lower extremity is associated with disease severity and functional disability. CONCLUSIONS CSP latencies in both upper and lower extremities in patients with FM are longer than in healthy volunteers. Moreover, prolongation of CSP latency in the lower extremity is associated with disease severity and physical functional disability.

A geriatric patient with spinal cord injury without radiographic abnormality: outcomes and causes

IntroductionAlthough the prognosis of spinal cord injury without radiographic evidence of abnormality (SCIWORA) depends on the severity of the initial neurological damage, most patients with American Spinal Injury Association impairment scale grade D are expected to recover fully.Case presentationAn 85-year-old patient with SCIWORA and urinary incontinence, who did not produce the expected response to rehabilitation, displayed the central, peripheral, and autonomic nervous system findings together. Conventional radiography, computed tomography, and even magnetic resonance imaging were unable to explain this complicated neurological condition thoroughly. More in-depth research into the patient’s history revealed some sequelae left by urinary surgery and chemotherapy.DiscussionComorbidities in geriatric SCIWORA have severe effects on both etiology and prognosis. Furthermore, incontinence in SCIWORA is an essential condition that has not been addressed until now and may play a role in prognosis.

The effect of sensory level electrical stimulation of the masseter muscle in early stroke patients with dysphagia: A randomized controlled study

Background: Dysphagia is a serious cause of morbidity and mortality in stroke patients. Aims: As the first study in literature, we aimed to evaluate the effects of sensory-level electrical stimulation (SES) to bilateral masseter muscles in early stroke patients with dysphagia. Settings and Design: This study was conducted at the Physical Medicine and Rehabilitation Clinic of our hospital between 2013 and 2015. Materials and Methods: Ninety-eight patients with dysphagia within the first month after ischemic stroke were included in this study. Patients were evaluated by bedside screening tests (Bedside Dysphagia Score, Neurological Examination Dysphagia Score, Total Dysphagia Score, and Mann Assessment of Swallowing Ability test) and by flexible fibreoptic endoscopic evaluation of swallowing (FEES) methods. All patients were included in a traditional swallowing therapy. Patients were divided into two groups, namely the “stimulation group” and “sham group.” SES was applied to bilateral masseter muscles. Evaluation parameters were compared between the groups before and after therapy. Statistical Analysis: The Friedman test, Wilcoxon Signed Rank test, Mann–Whitney U test, and Fisher exact test were used in this study. Results: There was a significant improvement in dysphagia severity scores evaluated by bedside screening tests and FEES in cognitive and total functionality levels except in motor functional independence level in the stimulation group. In the sham group, there were no significant changes in the evaluation parameters. Conclusion: SES applied to bilateral masseter muscles may provide an effective treatment for both dysphagia and cognitive function in early stroke patients.