Emrullah Hayta

Acute spinal cord injury: A review of pathophysiology and potential of non-steroidal anti-inflammatory drugs for pharmacological intervention

Acute spinal cord injury (SCI) is one of the serious central nervous system injuries, which can lead to significant neurological impairments and a reduction in quality of life with loss in sensory and motor functions. Although recent advancements contribute to the understanding of the underlying pathophysiological processes developed after SCI, currently, there is limited innovative and effective treatment options besides conventional rehabilitation and management of SCI to alleviate the condition. Improvements in neurological functions of the individuals with SCI depend mainly on the mechanical damage occurring in the primary injury and on pathophysiological alterations associated with secondary damage. Since in the treatment of SCI, there are no therapeutic strategies for neurological alterations caused by primary injury, all innovative treatments utilize treatment strategies targeting to the secondary damage. Non-steroidal anti-inflammatory drugs (NSAIDs) have become the focus of various experimental SCI models as these may be expected to reduce inflammation in secondary damage due to their potent anti-inflammatory effects. Experimentally, they exhibit neuro-protective and apoptotic effects by suppressing axonal re-growth, thus inhibiting the RhoA pathway, which leads to apoptotic cell death, in addition to the recovery of motor functions along with histological improvement. However, histological improvement is not significantly associated with improvement of motor function. The main target of SCI research should not only focus on histological improvement of lesion, but also on its potential for contribution to effective clinical therapies targeting improvements in sensory and motor functions. In the present review, we have summarized the current knowledge about pathophysiologic mechanisms working after SCI and discussed the potential of NSAIDs as promising agents in the management of SCI.

Additional Therapeutic Effect of Balneotherapy in Low Back Pain

Objectives: Balneotherapy has been widely used for treatment of chronic low back pain recently. However there are only a few clinical controlled trials on balneotherapy. The aim of the present study was to evaluate the effects of balneotherapy in patients with chronic low back pain. Methods: Sixty patients with lumbar spondylosis were included in the study. In Group 1, patients received both balneotherapy and physiotherapy and in Group 2, patients received only physiotherapy for three weeks. The intensity of the pain was evaluated by Visual Analog Scale (VAS) and functional disability was scored according to Revised Oswestry Index (ROI). Spinal mobility was assessed by the Schober and lateral flexion tests. Variables were evaluated before and after the three weeks of treatment. Results: The groups were comparable regarding age (P = 0.970) and sex (P = 0.357). There was no statistically significant difference between the two groups for baseline VAS (P = 0.838), Schober test (P = 0.226), and right (P = 0.642) and left (P = 0.674) lateral flexion measurements, and ROI scores (P = 0.798). At the end of the therapy, all clinical parameters significantly improved in patients in both of the groups (P < 0.05). VAS, Schober test, and ROI scores after the therapy were clearly superior in Group 1 in comparison to Group 2 (P < 0.05). Conclusion: The results of the present study reiterate that besides conventional physiotherapy, balneotherapy may be effective in the treatment of patients with chronic low back pain.

Serum cortisol and dehydroepiandrosterone-sulfate levels after balneotherapy and physical therapy in patients with fibromyalgia.

Objectives: To investigated serum cortisol and serum dehydroepiandrosterone-sulphate (DHEA-S) levels between fibromyalgia (FMS) patients and a control group, and the effect of balneotherapy (BT) on these hormones. Methods: Seventy-two patients with FMS and 39 healthy volunteers were included in the study. This prospective and cross-sectional study was carried out in the Medical Faculty, Physical Medicine and Rehabilitation Clinic, Cumhuriyet University, Cumhuriyet, Turkey between June 2012 and June 2013. Patients were divided into 2 groups. There were 40 patients in the first group, consisting of BT and physical therapy (PT) administered patients. There were 32 FMS patients in the second group who were only administered PT. Thirty-nine healthy volunteers were enrolled as a control group. Result: Cortisol was observed to be lower in FMS patients compared with the controls (10.10±4.08 μg/dL and 11.78±3.6 μg/dL; p=0.033). Serum DHEA-S level was observed to be lower in FMS patients compared with the controls (89.93±53.96 μg/dL and 143.15±107.92 μg/dL; p=0.015). Average serum cortisol levels of patients receiving BT were determined to be 9.95±3.20 μg/dL before treatment and 9.06±3.77μg/dL after treatment; while average serum DHEA-S levels were 77.60±48.05 μg/dL before treatment, and 76.84±48.71 μg/dL after treatment. No significant changes were determined in serum cortisol and DHEA-S levels when measured again after BT and PT. Conclusion: Low levels of serum cortisol and DHEA-S were suggested to be associated with the physiopathology of FMS.

Decrease of Serum IGF-1 Level is Not Associated With Obstructive Sleep Apnea in Fibromyalgia Patients

Objectives This study aims to investigate the relationship of serum insulin-like growth factor 1 (IGF-1) level with obstructive sleep apnea, the Pittsburgh sleep quality index (PSQI), age, body mass index, and fibromyalgia impact questionnaire (FIQ) in fibromyalgia syndrome (FMS) patients. Patients and methods A total of 105 female patients (mean age 41.8±9.0 years; range 26 to 55 years) with fibromyalgia (FMS group) who were diagnosed according to 2010 American College of Rheumatology criteria, and 51 female patients (mean age 39.9±10.8 years; range 24 to 54 years) with mechanical low back pain (MLBP) (control group) were included in the study. Age, smoking, educational status, tender point number, body mass index, duration of disease, FIQ, PSQI, and polysomnographic assessment of both FMS and control groups were recorded. Results Sleep disorder was detected in 88 patients in FMS group and 15 patients in control group (p<0.05). The PSQI score was higher in the FMS group compared to the control group (9.9±4.6 vs. 5.7±3.5). The FIQ score was higher in the FMS group compared to the control group (53.4±17.4 vs. 26.4±13.9; p<0.05). The serum IGF-1 level of FMS group was significantly lower than that of the control group (140.6±49.5 ng/mL vs. 177.2±58.5 ng/mL; p<0.05). In the FMS group, an examination of the correlation between serum IGF-1 level with the age, body mass index, obstructive sleep apnea syndrome, FIQ, and PSQI revealed a negative correlation between serum IGF-1 with the age and PSQI. The obstructive sleep apnea syndrome ratios of study groups were comparable with regard to the frequencies of mild, moderate, and severe obstructive sleep apnea syndrome. Conclusion In FMS patients, serum IGF-1 levels may decrease due to age and PSQI; however, this may not be related to the severity of obstructive sleep apnea.

Extracorporeal shock-wave therapy effectively reduces calcaneal spur length and spur-related pain in overweight and obese patients.

OBJECTIVE We aimed to evaluate the effects of extra corporeal shock-wave therapy (ESWT) on the calcaneal spur length and pain severity in overweight and obese patients with symptomatic calcaneal spur. METHODS In eighty patients with symptomatic calcaneal spur, ESWT was administered on days 0 and 7, and visual analog scale (VAS) scores and calcaneal spur lengths (CSLs) before and 3 months later after treatment were recorded. A lateral heel radiograph was used for computer-aided linear measurements of CSL. RESULTS Of 80 patients, 59 (73.7%) were female and 21 were male (26.3%); age was 45.9 ± 8.3 years; BMI was 31.6 ± 4.4 kg/m2; and symptom duration was 2.3 ± 2.4 years. The CSL and VAS score after treatment were significantly lower than those before treatment (CSL before vs. after: 5.7 ± 1.0 vs. 4.4 ± 0.9, p = 0.001; VAS score before vs. after: 8.3 ± 1.4 vs. 4.6 ± 2.2; p = 0.03). The CSLs before and after treatment had a significant strong correlation (r = 0.832, p = 0.001). The VAS scores before and after treatment presented a significant mild correlation (r = 0.242, p = 0.03). CONCLUSIONS In overweight and obese patients with symptomatic calcaneal spur, ESWT reduces the CSL and pain severity during a follow-up of three-month duration.

Is There a Clinically Meaningful Change in the Blood Pressure of Osteoarthritis Patients with Comorbid Hypertension During the Course of Balneotherapy

Background: Balneotherapy (BT) is a treatment modality that uses the physical and chemical effects of water, including thermomineral, acratothermal, and acratopegal waters. It has many effects on cardiovascular system. Aim: The aim of the study is to investigate the effects of 3-week BT on blood pressure of osteoarthritis (OA) patients with no hypertension (HT), and controlled or uncontrolled HT. Materials and Methods: The OA patients (n = 270) were divided into three groups: No HT, controlled HT, and uncontrolled HT. All the groups received BT in the facilities of our university hospital at the same time every day (10:00-11:30 AM) for 10 min per day, 5 days per week, for a total duration of 15 days in a 3-week period. Systolic and diastolic blood pressures and pulse rates were measured before and after BT on daily basis. Results: Overall, (1) the pulse rates of study groups measured after BT were significantly increased compared to before BT; (2) the systolic blood pressures of study groups measured before and after BT were found as comparable; and (3) the diastolic blood pressures of no HT and controlled HT groups measured before and after BT were not statistically significant (P > 0.05); however, in the uncontrolled HT group, the diastolic blood pressure showed a decreasing trend after BT (P < 0.05). Conclusions: In patients with OA, BT can be safely used without resulting in any meaningful changes in systolic and diastolic blood pressures in patients with normal and controlled HT but a decrease in diastolic blood pressure of patients with uncontrolled HT. This may be an advantage in OA patients having HT as comorbid disease.

AB0786 Circadian Rhythm of Melatonin in Ankylosing Spondylitis: Correlation with Disease Activity, Quality of Life and Enthesitis Score

Background Due to its effect on the immune system and antioxidant features melatonin (MLT) has attracted a great deal of attention in recent years. Its role in pathogenesis of chronic inflammatory diseases have been studied. However only few studies have investigated its role in Ankylosing Spondylitis (AS). Objectives The aim of this study is to investigate the circadian rhythm of MLT and its relationship with disease activity, quality of life and enthesitis score in AS patients. Methods Sixteen AS patients diagnosed according to the Modified New York 1984 criteria and 16 age and sex matched healthy controls were enrolled in the study. Serum MLT levels were measured at 20:00, 03:00 and 08:00 via melatonin direct radioimmunoassay kit (LDN BA R-3300) in both groups. Bath AS Disease Activity Score (BASDAI), Bath AS Functional Index (BASFI), Maastricht AS Enthesitis Score (MASES) and AS Quality of Life (ASQoL) were calculated in AS group. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were measured, duration of morning stiffness was questioned Results The mean morning (08:00) and evening (20:00) MLT levels were significantly higher in the patient group (34.00±13.51 pg/ml versus 24.88±7.10 pg/ml and 34.25±7.92 pg/ml versus 27.75±8.25 pg/ml respectively) (p<0.05). The mean MLT level at night (03:00) was also higher in AS group but the difference did not reach statistical significance. (98.81±39.16 pg/ml versus 73.94±30.49 pg/ml) (p:0.054). A significant positive correlation was found between morning and night MLT levels and duration of morning stiffness, BASDAI, BASFI, ASQoL and MASES scores. No significant correlation was found between evening MLT levels and these parametres. Also no correlation was found between acute phase reactants (ESR,CRP) and the MLT levels.(Table) Conclusions Ankylosing Spondylitis patients have higher melatonin levels and the melatonin levels of AS patients are associated with the duration of morning stiffness, disease activity, quality of life and enthesitis scores. We suggest that our results should be supported by studies performed in wider study populations also involving patients with non-radiographic axial spondyloarthritis as a subgroup and with more frequent melatonin measurements performed especially at night in order to assess the exact circadian rhythm of melatonin in spondyloarthritis. References Cutolo M, Maestroni GJ,Otsa K, Aakre O, Villaggio B, Capellino S et al. Circadian melatonin and cortisol levels in rheumatoid arthritis patients in winter time: a north and south Europe comparison. Ann Rheum Dis 2005;64:212-216 Senel K,Baykal T, Melikoglu MA, Erdal A, Karatay S, Karakoc A, Ugur M. Serum melatonin levels in ankylosing spondylitis: correlation with disease activity. Rheumatol Int 2011;31:61-63 Senna MK, Olama SM, El-Arman M. Serum melatonin level in ankylosing spondylitis: is it increased in active disease. Rheumatol Int 2012;32:3429-3433. Disclosure of Interest None declared

Obstrüktif uyku apne sendromu ve fibromiyalji sendromu birlikteliği

Ozet Amac: B u calismada her iki hastalikta da dinlendirmeyen uyku, gunduz asiri uyuma ihtiyaci, sabahlari olan bas agrisi gibi ortak semptomlarin varligindan yola cikarak OUAS hastalarinda FMS birlikteligini incelemeyi amacladik. Yontem: OUAS suphesi olan 100 ardisik hasta alindi. Bu hastalara polisomnografi (PSG) uygulandi ve FMS acisindan fizik tedavi uzmani tarafindan degerlendirildi. OUAS tanisi icin Uluslararasi Uyku Bozukluklari Siniflamasi (ICSD-2) kriterleri, FMS tanisi icin Amerika Romatoloji Dernegi (ACR)’nin 1990 yilinda yayimladigi ve gunumuzde kullanilan kriterler temel alindi. Bulgular: Yuz hastanin 74’unde OUAS saptandi. OUAS saptanan 74 hastanin 20‘sinde (%27) FMS saptanirken OUAS olmayan 26 hastanin 4’unde (%15,4) FMS saptandi ve her iki grup arasinda FMS sikligi acisindan istatiksel anlamli fark yoktu. OUAS olan gruptaki hastalari FMS varligi ve yokluguna gore gruplara ayirdigimizda ve bu gruplar arasinda horlama, tanikli apne, gunduz asiri uyku hali (GAUH) ve uc major semptom birlikteligini kiyasladigimizda tanikli apne ve GAUH sadece OUAS olan FMS olmayan grupta istatiksel olarak anlamli oranda daha yuksekti (p 0,05). Sonuc: Sonuc olarak calismamizda OUAS’li hastalarda FMS birlikteligi acisindan anlamli iliski saptamasak da GAUH, dinlendirmeyen uyku, sabahlari olan bas agri gibi ortak semptomlarin varligi daha genis orneklemli ve daha cok sayida calismalara ihtiyac oldugunu gostermektedir. Anahtar sozcukler : Uyku apne, fibromyalji Abstract Aim. W e aimed to study coexistence of FMS in OSAS patients since there are common symptoms such as non-relaxing sleep, over need for sleep during the day, morning headaches in both diseases. Methods. 100 consecutive OSAS patients contributed to the study. These patients are evaluated by physical rehabilitation specialist with application of polysomnography (PSG). International Classification of Sleep Disorders (ICSD-2) criteria used for OSAS diagnosis and American College of Rheumatology (ACR) criteria published in 1990 and some criteria which are used today used for diagnosis for FMS. Results. OSAS determined in 74 patients of 100. While in 20 of 74 patients (27%) with OSAS FMS determined, in 4 of 26 patients with no OSAS (15.4%) FMS determined and there was no statistical difference in regards to FMS incidence between groups. In OSAS group, when groups separated according to FMS existence and absence and when coexistence of symptoms such as witnessed apnea, excessive day time sleepiness (GAUH), and 3 major symptoms only witnessed apnea and GAUH was statistically high, in only OSAS non-FMS group (p 0.05). Conclusion. In conclusion, although we did not determined significant coexistence of FMS in OSAS patients, common symptoms such as GAUH, non-relaxing sleep, morning headaches shows that further study need to be done in large scales. Key words : Sleep apnea, fibromyalgia