Erkam Kömürcü

Neutrophil-Lymphocyte Ratio Connected to Treatment Options and Inflammation Markers of Ankylosing Spondylitis.

In recent years, white blood cells (WBCs) and their subtypes have been studied in relation to inflammation. The aim of our study was to assess the relationship between neutrophil–lymphocyte ratio (NLR) and ankylosing spondylitis (AS).

Mean platelet volume and platelet distribution width can be related to bone mineralization

SummaryPlatelets functions are related to bone resorption and formation. The present study aimed at studying the association between platelet function and bone mineralization. We showed that mean platelet volume (MPV) and platelet distribution width (PDW) levels in osteoporosis patients increased. The study also showed that PDW and age independently associated with bone mineralization.IntroductionMPV and PDW are widely used for assessing platelet function. Recently, authors argued that platelet function has an important role in bone mineralization. However, only one study has investigated the relationship between MPV and osteoporosis. We aimed to study the levels of MPV and PDW in postmenopausal osteoporosis.MethodsWe investigated 320 bone mineral density (BMD) measurements between the years 2012 and 2013 retrospectively in our clinic. Eighty patients whom chronic diseases are absent and all laboratory findings are complete enrolled in this study. Patients were divided in three groups as an osteoporosis, osteopenia, and normal BMD group. MPV and PDW levels were investigated in these groups. We performed correlation test and linear regression analysis to determine whether there is a relationship between platelet function markers and BMD measurements.ResultsEighty patients were divided as an osteoporosis, osteopenia, and normal BMD group. MPV levels and PDW levels in the osteoporosis group were lower than the normal BMD group. PDW was positively correlated with femur total T (FTT) score and lumbar 1–4T (L1–4T) scores. Linear regression analysis showed that age and PDW were independently related to FTT and LTT scores.ConclusionPlatelet functions are related to the bone mineralization. PDW and MPV have a significant role in the development of postmenopausal osteoporosis.

Association between mean platelet volume and bone mineral density in patients with ankylosing spondylitis and diagnostic value of diffusion-weighted magnetic resonance imaging.

[Purpose] The aim this study was to assess the relation between bone mineral density (BMD) and mean platelet volume (MPV) in ankylosing spondylitis (AS) patients, and evaluate the diagnostic role of the diffusion-weighted magnetic resonance imaging (MRI). [Subjects and Methods] Fifty patients diagnosed with AS were divided into two groups on the basis of BMD, a normal group (n=30) and an osteopenic (n=20) group. [Results] Duration of disease in the group with a normal BMD was 10.3±7.0 years, while it was 16.7±12.2 years in the osteopenia group. MPV was high in the osteopenia group, while no significant differences were observed between the groups in terms of apparent diffusion coefficient (ADC) and platelet distribution width (PDW). There was a positive correlation between MPV and duration of disease. Correlations between ADC value and the lumbar T score, femoral neck T score, and duration of disease were insignificant. A negative correlation was observed between BMD and disease duration. [Conclusion] Diffusion-weighted imaging provides valuable results in osteoporosis but is not a suitable technique for evaluating BMD in patients with AS because of the local and systemic inflammatory effects in the musculoskeletal system. The common pathophysiology of atherosclerosis and osteoporosis plays an important role in the negative correlation observed between MPV and BMD in patients with AS.

RELATIONSHIP BETWEEN EXTREMITY FRACTURES AND ATTENTION-DEFICIT/HYPERACTIVITY DISORDER SYMPTOMATOLOGY IN ADULTS

Objective: Recent studies showed that attention deficit hyperactivity disorder (ADHD) is a lifelong disorder which may be seen in adults as well as children. However, information about the relationship between ADHD and general medical conditions in adulthood is limited. This case-control study aims to determine whether ADHD symptoms are associated with extremity fractures and their clinical characteristics. Methods: Forty patients (25 male and 15 female; aged 18–50 years) who were seen due to extremity fractures and 40 control subjects were enrolled. Childhood and present ADHD symptoms of the participants were assessed using Wender Utah Rating Scale (WURS) and Adult ADHD Self-Report Scale (ASRS), respectively. Trauma type, reason of the trauma, fracture localization, hospitalization requirement, treatment type, and history of previous fracture(s) of the patients were recorded. Results: Total score and all subscale scores of WURS were higher in the fracture groups compared with controls. Patients also had higher ASRS total score and ASRS hyperactivity-impulsivity subscore than the controls did. WURS irritability, inattentiveness, and behavioral problems/impulsiveness subscore and total score were positively correlated with the history of previous fracture. The patients in whom the reason for the fracture was fighting were also showed higher WURS irritability subscore. Conclusions: Our results suggest that extremity fractures are associated with ADHD symptoms in adults. These findings may provide an insight into better understanding the lifelong negative impact of ADHD on the physical health of its sufferer.

Preventive effects of coenzyme Q10 (CoQ10) on steroid-induced osteonecrosis in rats.

OBJECTIVE The aim of this study was to examine the role of coenzyme Q10 (CoQ10) in the prevention of steroid-induced osteonecrosis of the femoral head (ONFH) in rats. METHODS The study included 20 Sprague-Dawley rats injected once with 20 mg/kg of methylprednisolone acetate into the right gluteus medius muscle to induce osteonecrosis. Animals were divided into two equal groups; Group 1 received no prophylaxis (control group) and the Group 2 received CoQ10. Hematological examinations were performed before steroid injection (0 weeks) and at 4 weeks after steroid injection. Femoral heads were examined histologically to evaluate osteonecrosis. RESULTS Changes in blood glutathione (GSH) and malondialdehyde (MDA) concentrations were less significant in the CoQ10 group. The incidence of histologic changes consistent with early osteonecrosis was lower in the CoQ10 group (2 of 10; 20%) than the control group (7 of 10; 70%). CONCLUSION Coenzyme Q10 may be useful as a preventing agent in steroid-induced ONFH. Inhibited oxidative stress is a possible mechanism for this effect.

Comment on the article "Dual 8-plate technique is not as effective as ablation for epiphysiodesis about the knee" by Stewart et al.

To the Editor: We read with interest the recent article “Dual 8-Plate Technique Is Not as Effective as Ablation For Epiphysiodesis About the Knee” by Stewart et al1 The authors conducted a study to determine the effectiveness of dual 8-plate and ablation epiphysiodesis techniques in the treatment of limb length discrepancy and concluded that physeal ablation is a significantly superior treatment option compared with dual 8-plates for epiphysiodesis. We think that this is an important topic for study, but question some of the study design methodologies. First of all, although the demographic properties are similar (age, sex), we do not know the diagnosis of the patients treated. Effectiveness of a treatment may differ in different types of disorders. Secondly, although ideally the study should evaluate the efficacy of each treatment on tibial and femoral parts independently, the median improvement in limb length discrepancy is evaluated for the extremity as a whole and not for femoral and tibial parts independently. In the methodology section, we see that there is a heterogenous group of patients treated with distal femur and/or proximal tibial epiphysiodesis for limb length inequality. This means that some of the patients were treated with both femoral and tibial epiphysiodesis and some of them with only femoral or tibial epiphysiodesis. Patients treated with both femoral and tibial epiphysiodesis (2-sided treatment) and those treated with only femoral or tibial epiphysiodesis (1-sided treatment) were included in the same group and the effect of epiphysiodesis on extremity growth was evaluated. Of course the effect of 2-sided treatment would be better than that of 1sided treatment. We do not know how many of the patients were treated with both femoral and tibial epiphysiodesis and how many of them were treated with only tibial or femoral epiphysiodesis and whether they were similar in ablation and 8-plate epiphysiodesis groups. If the number of patients undergoing 1-sided treated was more than that of the 2-sided treatment in the 8-plate group then the median value would be the value of one of the patients undergoing 1-sided treatment. Thirdly, the effectiveness of 8plate treatment is dependent on the correct surgical technique. The plate should be centered on the physis and should be inserted using 1 screw above and 1 below the physis, with an attempt to angle the screws away from the physis to speed the rate of tethering (not parallel).2,3 This is emphasized in the article as well; however, we suspect that not all the surgeries have been conducted by paying attention to this technique. Because when we observed the radiogram in Figure 1, we noticed that on the tibial side 8 plates were not holding the physis and on the fibular side the plate screws were parallel. Although the authors concluded that the physeal ablation is a significantly superior treatment compared with dual 8-plates for epiphysiodesis, we believe that the study method has limitations. We believe that these limitations should be eliminated before recommending the discontinuation of use of medial and lateral 8 plates for epiphysiodesis.

Effect of systemic carnitine therapy on serum fibronectin level in diabetic rats

BACKGROUND L-carnitine has been shown to enhance wound healing. There has, however, not been sufficient research on the effect carnitine has on diabetic wound healing. We investigated the relationship between the viability of full thickness skin grafts (FTSGs) and fibronectin (FN) serum levels in diabetic rats that were administered carnitine. MATERIALS AND METHODS A total of 40 rats were divided into four groups of 10 rats each and operated on. The FTSG model was 10 × 3 cm, with the dorsal flap extending from the tip of the scapula to the hip joint. After surgery, group 1 (nondiabetic control, n = 10) and group 2 (diabetic control, n = 10) were given a sterile saline solution at 0.9% with a dose of 100 mg/kg/d intraperitoneally for 7 d after the surgery. Group 3 (diabetic sham, n = 10) contained diabetic rats and did not receive any agent after the surgery. The diabetic rats in group 4 (carnitine study diabetic, n = 10) were given carnitine with a dose of 100 mg/kg/d intraperitoneally for 7 d after the surgery. RESULTS The percentages of viable areas in groups 1-4 were 70.38 ± 6.10%, 62.66 ± 1.55%, 62.59 ± 2.94%, and 73.48 ± 4.43%, respectively. The mean levels of FN, measured in milligram per deciliter, in groups-4 were 23.57 ± 3.27 mg/dL, 21.58 ± 2.35 mg/dL, 22.04 ± 2.71 mg/dL, and 27.11 ± 2.79 mg/dL, respectively. Furthermore, we found that there was a strong positive correlation (R = 0.509; P = 0.001) between FN and the viability of the FTSG. CONCLUSIONS We demonstrated that administering carnitine leads to an increase in diabetic wound healing. Further increasing the levels of the FN serum might have a role in this process.

Popliteal schwannoma mimicking baker cyst: an unusual case

Schwannoma, also known as neurilemoma, is the most common tumour of peripheral nerves. Although it is the most common tumour of peripheral nerves, it is seldom seen in adult population. We present a very rare case of schwannoma in an unusual localization. The presented case concerns a 58-year-old patient with a slowly growing popliteal mass and neuralgia for 6 months. A mass originating from a nerve or compressing a nerve was thought in the differential diagnosis. Ultrasonographic and magnetic resonance imaging revealed a heterogenous, well-defined solid mass that seems to originate from tibial nerve. Surgical excision and histopathological examination confirmed the diagnosis of schwannoma. Diagnosis of the neurilemmoma originating from lower extremity peripheral nerves may be delayed because the mass can be misdiagnosed as baker cyst or the symptoms of the patient can be thought as a result of lumber disc herniation.

Consultation of traditional bone setters instead of doctors: is it a sociocultural and educational or social insurance problem?

Background Patients consulting bone setters is common in the eastern and south-eastern regions of Turkey. The reasons for consulting bone setters instead of qualified doctors remains unclear. We investigated the characteristics of such patients who consult traditional bone setters after trauma prior to admission to hospital. Methods In the study, 3,422 of 14,080 patients were investigated admitted to hospital between January 2012 and February 2013 with trauma or sequelae of such who were previously treated by bone setters. The characteristics of these patients and the main reasons for consultation of bone setters instead of doctors were recorded. Results Most of the patients consulting bone setters were found to be young adults or children. Generally speaking, the poorly educated prefer bone setters despite having social insurance. The most common reason (29.3%) was a general preference and secondarily (27.1%) the fear of being disabled after medical treatment. However, the most common cause of patients’ consultation at hospital subsequently was due to complications of treatment (46.8%); indeed the complication rate after bone setters’ intervention was found to be 54.8%. Conclusion Although improvements have occurred in the access to and utilisation of healthcare services, consultation by patients of bone setters seems to be a sociocultural and educational issue rather than a problem of lack of medical insurance.

The Effect of Intraoperative Sounds of Saw and Hammer on Psychological Condition in Patients with Total Knee Arthroplasty: Prospective Randomized Study

Purpose. Surgical procedures are likely to be stressful for patients and their families. Total knee arthroplasty (TKA) is a major surgical procedure used in the treatment of osteoarthritis. During this procedure the sounds of the saw and hammer may irritate the patient and adversely affect mood. The present study examines the effect of these intraoperative sounds during TKA on postoperative mood and anxiety, by comparing two different anesthetic procedures. Methods. A total of 40 patients who underwent TKA for grade IV gonarthrosis participated in the study. Patients were randomly divided into two groups: 20 patients in the general anesthesia group and 20 patients in the spinal anesthesia group. Mood and anxiety changes were evaluated using the Profile of Mood States (POMS) and State-Trait Anxiety Inventory (STAI) instruments, respectively. Results. The postoperative POMS value in the spinal anesthesia group was definitively higher than the general anesthesia group, though the difference in preoperative and postoperative POMS and STAI scores between the two groups was not significant. Conclusion. It would seem that sounds of hammer and saw have no evident negative effect on patients mood. Regional anesthesia is advisable for TKA patients and appropriate sedation can be administered during the operation if needed.