Mahir Ugur

The effectiveness of gabapentin in patients with chronic radiculopathy

AbstractThis study was carried out to determine the efficacy of gabapentin in patients with radiculopathy. Fifty patients (32 women, 18 men) with lumbosciatalgia secondary to L5 or S1 radiculopathy were evaluated. MRI showed L4-5 and/or L5-S1 bulging and/or protrusion without significant spinal stenosis. Baseline assessments for each patient included a standard neurological examination and radiological investigation. The patients were randomly assigned into two groups: group 1 was treated with oral gabapentin from a total of 900 mg per day up a total of 3600 mg per day divided in 3 doses; group 2 received placebo for the 8-week trial period. In group 1 we observed statistically significant improvement in pain at rest (p < 0.001), motor function (p < 0.01), limitation of spinal flexion (p < 0.001), straight leg raising test (p < 0.001) and sensory function (p < 0.001). Stretch reflexes instead did not significantly change. In group 2 we observed significant improvement in all clinical parameters, muscle st...

Pattern of Disease Onset, Diagnostic Delay, and Clinical Features in Juvenile Onset and Adult Onset Ankylosing Spondylitis

Objective. To assess the frequency of juvenile onset ankylosing spondylitis (JOAS) in Turkish patients with AS and to compare with adult onset AS (AOAS) in a cross-sectional study design. Methods. A total of 322 patients were recruited from the joint database of 5 university hospitals in eastern Turkey. Results. Patients with JOAS (n = 43, 13.4%) had significantly longer diagnostic delay (9.21 vs 5.08 yrs), less severe axial involvement and more prevalent uveitis (OR 2.92, 95% CI 1.25–6.79), and peripheral involvement at onset (OR 3.25, 95% CI 1.51–6.98, adjusted for current age; and OR 2.26, 95% CI 1.07–4.76, adjusted for disease duration). Patients with AOAS had higher radiographic scores and more restricted clinimetrics but similar functional limitations and quality of life. Conclusion. JOAS and AOAS had distinctive courses and Turkish patients with AS had similar features compared to other Caucasian patient populations.

Expert opinion and key recommendations for the physical therapy and rehabilitation of patients with ankylosing spondylitis

Aim:  Physiotherapy is an integral part of the management of ankylosing spondylitis (AS) and there is a need for recommendations which focus on the rehabilitation of patients with AS. We aimed to develop recommendations for the physical therapy and rehabilitation of patients with AS based on the evidence and expertise.

Relationship between some acute phase reactants and the bath ankylosing spondylitis disease activity index in patients with ankylosing spondylitis

Objectives The aims of this study were to investigate a possible relationship between the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and some acute phase reactant (APR) levels in patients with ankylosing spondylitis (AS). Methods Twenty outpatients who fulfilled the modified New York criteria for AS were included in the study. Laboratory activity was assessed by examining erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), haptoglobin (Hp), and &bgr;2 microglobulin (&bgr;2MG). Disease activity was assessed according to the BASDAI, which includes a 10-point visual analogue scale to measure pain, fatigue, morning stiffness, swelling, and areas of local tenderness. Results When APR values were analyzed for the BASDAI, a positive correlation between CRP and BASDAI was observed (r = 0.556, P < 0.05). There was no clear, statistically significant correlation between BASDAI and the other APRs (ESR, r = 0.328, P > 0.05; Hp, r = 0.035, P > 0.05; and &bgr;2MG, r = −0.190, P > 0.05). Conclusions Our data suggest that CRP is a better marker of disease activity than ESR, Hp, and &bgr;2MG.

Discrimination ability of ASDAS estimating disease activity status in patients with ankylosing spondylitis.

Objectives:  To investigate discrimination ability of the Assessment of Spondyloarthritis International Society (ASAS) endorsed disease activity score (ASDAS) versions evaluating low and high disease activity in an unselected group of patients with ankylosing spondylitis (AS).

Gabapentin monotherapy in patients with chronic radiculopathy: The efficacy and impact on life quality

OBJECTIVE The purpose of this, open-label, non-comparative study, was to evaluate the efficacy on quality of life and the efficacy of gabapentin monotherapy in patients with chronic radiculopathy. METHODS Thirty-five patients with radicular pain and diagnosed as L4, L5 or S1 radiculopathy were treated with oral gabapentin from a total of 300 mg per day once up to a total of 1800 mg per day divided in 3 doses for eight-week trial period. Quality of life, functional disability and psychological mood of the patients were assessed using the Nottingham Healthy Profile (NHP), Oswestry Low Back Pain Disability Questionnaire (ODQ) and Beck Depression Inventory (BDI). RESULTS Of the patients (n = 35), 25 were females and 10 were males (mean age: 41.8 +/- 10.4, range: 24-60 years); mean radiculopathy duration was 16.4 +/- 14.2 months (range: 3-48 months). The pain intensity at rest, quality of life, functional disability and depression scores were determined significantly improved after treatment and 4 months compared to baseline scores (p < 0.001). 1.5 points compared to baseline for at pain rest and 15 points improvement on the ODQ were obtained. CONCLUSION Gabapentin may provide benefits in terms of alleviation of pain and overall quality of life in patients with chronic radiculopathy.

Left Atrial Mechanical Functions in Elite Male Athletes

I athletic conditioning is associated with hemodynamic changes and affects the loading conditions of the heart. It is known that the heart of an athlete has become physiologically adapted by prolonged training. These changes include an increase in left ventricular (LV) chamber size, wall thickness, and mass. It is reported that athletes involved in mainly static or isometric exercise develop concentric hypertrophy, and in contrast to this, athletes involved in endurance training or isotonic exercise develop eccentric hypertrophy. There are a large number of echocardiographic studies on LV wall thickness and dilatation, but there are very few studies concerning left atrial (LA) mechanical function in the athlete’s heart. This study was undertaken to assess the possible adaptive changes in LA mechanical function in elite athletes. • • • Thirty-six top-level male athletes (21 4 years), all members of the national running team, wrestling team, skiing team, or other professional sports teams (14 runners, 10 wrestlers, 4 boxers, 5 basketball players, and 3 skiers) and 21 age-matched healthy male controls (21 4 years) were included. Mean athletic competition time was 7.7 4.1 years and the mean average training time was 11.5 3.9 hours/week in the athletes. All athletes were in the intense training period. Athletes in the off-training period or during prolonged rest ( 10 days) were not included. All subjects enrolled in this study were free from cardiac disease on the basis of a negative medical history and normal physical examination and electrocardiogram. The subjects who had a history of taking any cardioactive medication or anabolic steroids were excluded from this study. The study protocol was approved by the ethics committee of our institute and all subjects gave written consent for the study. A Vingmed System Five Doppler echocardiographic unit (GE Vingmed Ultrasound, Horten, Norway) with 2.5-MHz FPA probe was used. All echocardiograms were recorded by the same investigator. An echocardiographic study was performed in the left lateral decubitus position, with parasternal long and apical 2-, 4-, and 5-chamber views. Diastolic ventricular septal thickness, diastolic posterior wall thickness, and LV end-diastolic and end-systolic dimensions were measured in the parasternal long-axis view, and LV mass was determined by the method of Devereux and Reichek and indexed to body surface area. A sample volume of pulsed-wave Doppler was placed between tips of mitral leaflets on the apical 4-chamber view. Peak early (E) and late (A) mitral inflow velocities, E/A ratio, and deceleration time of E velocity were obtained. Isovolumic relaxation time was obtained with the sample volume of the pulsedwave Doppler positioned between mitral inflow and LV outflow tract as the time interval from the cessation of aortic flow to the onset of mitral valve inflow. LV end-diastolic and end-systolic volumes were determined from the apical 4-chamber view according to the modified Simpson’s method, and LV stroke volume and ejection fraction were calculated. LA volumes were measured echocardiographically at the time of mitral valve opening (maximal, Vmax), at the onset of atrial systole (p wave on electrocardiography Vp), and at mitral valve closure (minimal, Vmin) according to the biplane area-length method in the apical 4and 2-chamber view. All volumes were corrected for body surface area and the following LA emptying functions were calculated: LA passive emptying volume Vmax Vp; LA passive emptying fraction LA passive emptying volume/Vmax; conduit volume LV stroke volume (Vmax Vmin); LA active emptying volume Vp Vmin; LA active emptying fraction LA active emptying volume/Vp; LA total emptying volume (Vmax Vmin); LA total emptying fraction LA total emptying volume/ Vmax. 10 All measurements were averaged over 3 cardiac cycles. Data are expressed as mean SD. The differences between groups were assessed with the Student’s t test. The relation between different variables was assessed with the Pearson correlation. A p value 0.05 was considered statistically significant. Athletes and members of the control group did not differ significantly in mean age and body surface area (21 4 vs 20 4 years and 1.8 0.2 vs 1.8 0.2 m, respectively, p 0.05). Heart rate was significantly lower in athletes than in controls (p 0.001). Systolic and diastolic blood pressures were similar in both groups (p 0.05). LV end-diastolic diameter and volume were significantly higher in athletes than in controls (p 0.05). LV end-systolic diameter and volume and ejection fraction were similar in the 2 groups (p 0.05). Posterior wall thickness (p 0.01), ventricular septal thickness (p 0.001), and LV mass index (p 0.001) were significantly greater in athletes than in controls. E and A transmitral flow velocity, and E/A ratio were similar in both groups (p 0.05). LA dimension was significantly greater in athletes than in controls (p 0.005) (Table 1). LA volume indexes, Vmax (p 0.005), Vmin (p 0.05), and Vp (p 0.005) were greater in athletes From the Department of Cardiology, Medical School Hospital, and Department of Physical Education and Sport, Ataturk University, Erzurum, Turkey. Dr. Erol’s address is: Ataturk University, Department of Cardiology, Medical School Hospital, 25050 Erzurum, Turkey. E-mail: mkerol@superonline.com.tr. Manuscript received April 10, 2001; revised manuscript received and accepted June 7, 2001.

Circulating vascular endothelial growth factor concentrations in patients with postmenopausal osteoporosis.

Introduction The role of vascular endothelial growth factor (VEGF) in osteoporosis has not yet been clearly established. Vascular endothelial growth factor is an important part of bone formation. In the literature, although the effects of VEGF on bone metabolism were investigated by different studies, there are very rare studies analysing the association between osteoporosis and VEGF. In the present study, our objective was to investigate serum VEGF concentrations in patients with postmenopausal osteoporosis (PMO) and the correlation of serum VEGF levels and bone mineral density (BMD). Material and methods This study was performed on 35 PMO patients, and 30 age-matched healthy controls. Serum VEGF concentrations were measured using a quantitative sandwich enzyme immunoassay technique according to the manufacturers instructions. Bone mineral density values were determined by dual energy X-ray absorptiometry (DEXA). Results Serum VEGF concentrations were statistically significantly lower in PMO patients than in controls (150 ±65 pg/ml, 260 ±135 pg/ml respectively; p = 0.005). A positive correlation was found between serum VEGF concentrations and BMD values (r = 0.63, p = 0.001). Conclusions Vascular endothelial growth factor concentrations were decreased in PMO patients and VEGF may play an important role in bone health.

Psychological status is associated with health related quality of life in patients with rheumatoid arthritis

Objective: Rheumatoid arthritis (RA) is a chronic and disabling disease frequently effects physical and psychological well being. The aim of the present study was to determine the impact of psychological status on health related quality of l ife in patients with RA and also to assess which quality of life (QoL) instrument - disease specific and generic - is more prone to t his effect. Methods: A total of 421 patients with RA recruited from joint database of five tertiary centers. Depression and anxiety risks were assessed by the Hospital Anxiety and Depression Scale (HADS); and quality of life assessed by Rheumatoid Arthritis Quality of Life (RAQoL), Nottingham Health Profile (NHP) and The Short Form 36 (SF 36) questionnaire. Results: Patients with higher risk for depression or anxiety had poorer quality of life compared to the patients without risk for depression or anxiety. Depression and anxiety scores significantly correlated with quality of life questionnaires. Th ere was significant association between anxiety and depression wit h worsening in both disease specific and generic health relat ed quality of life. However, RAQoL showed more association with depression and anxiety levels. Conclusion: Higher depression and anxiety risks showed increased deterioration in quality of life. Compared to generic QoL scales, RAQoL scale, a disease specific QoL instrument, is mu ch more influenced by depression and anxiety.

Protracted febrile myalgia syndrome in familial Mediterranean fever

Familial Mediterranean fever (FMF) is an autosomal, recessively inherited multisystem disease that affects various groups of people originating from the Mediterranean Sea region, most specifically those of Jewish, Turkish, Armenian, and Arabic ethnicity. Recurrent attacks of fever and sterile polyserositis of the peritoneum, synovial membranes, and pleura are the main clinical features, although the clinical features of FMF have been expanded in recent years to also include severe myalgia, scrotal swelling, cardiac involvement, and protracted febrile myalgia syndrome (PFMS). PFMS is seen in only a small percentage of FMF patients and is characterized by severe debilitating myalgia of the upper and lower extremities and high fever, occasionally accompanied by abdominal pain, diarrhea, arthritis/arthralgia, and transient vasculitic purpura mimicking Henoch-Schönlein purpura (HSP). Here, we report on a patient with FMF who also presents with PFMS, which is an uncommon and severe manifestation of the disease.