Meryem Saracoglu

The effects of incremental speed-dependent treadmill training on postural instability and fear of falling in Parkinson's disease

Objective : To detect the effectiveness of incremental speed-dependent treadmill training on postural instability, dynamic balance and fear of falling in patients with idiopathic Parkinsons disease. Design : Randomized controlled trial. Setting : Ankara Education and Research Hospital, 2nd PM&R Clinic, Cardiopulmonary Rehabilitation Unit. Subjects : Fifty-four patients with idiopathic Parkinsons disease in stage 2 or 3 of the Hoehn Yahr staging entered, and 31 patients (21 training, 10 control) had outcome data. Interventions : Postural instability of patients with Parkinsons disease was assessed using the motor component of the Unified Parkinsons Disease Rating Scale (UPDRS), Berg Balance Test, Dynamic Gait Index and Falls Efficacy Scale. Twenty-one patients with Parkinsons disease participated in an eight-week exercise programme using incremental speed-dependent treadmill training. Before and after the training programme, balance, gait, fear of falling and walking distance and speed on treadmill were assessed in both Parkinsons disease groups. Main measures : Walking distance and speed on treadmill, UPDRS, Berg Balance Test, Dynamic Gait Index and Falls Efficacy Scale. Results : Initial total walking distance of the training group on treadmill was 266.45 ± 82.14 m and this was progressively increased to 726.36 ± 93.1 m after 16 training session (P < 0.001). Tolerated maximum speed of the training group on treadmill at baseline was 1.9 ± 0.75 km/h and improved to 2.61 ± 0.77 km/h (P < 0.001). Berg Balance Test, Dynamic Gait Index and Falls Efficacy Scale scores of the training group were improved significantly after the training programme (P < 0.01). There was no significant improvement in any of the outcome measurements in the control group (P > 0.05). Conclusions : Specific exercise programmes using incremental speed-dependent treadmill training may improve mobility, reduce postural instability and fear of falling in patients with Parkinsons disease.

Cycling progressive resistance training for people with multiple sclerosis: a randomized controlled study.

Çakıt BD, Nacir B, Genç H, Saraçoğlu M, Karagöz A, Erdem HR, Ergün U: Cycling progressive resistance training for people with multiple sclerosis: A randomized controlled study. Objective:To evaluate the effects of cycling progressive resistance training combined with balance exercises on walking speed, balance, fatigue, fear of falling, depression, and quality of life in patients with multiple sclerosis. Design:In this prospective randomized controlled trial, 45 patients were randomized into two exercise training (n = 30) groups and one control (n = 15) group. The patients in training group 1 (n = 15) underwent progressive resistance training on a bicycle ergometer and balance exercise, whereas group 2 (n = 15) patients received a home-based lower-limb strengthening and balance exercise. Outcome measures, including the duration of exercise, tolerated maximum workload, timed up and go test, Dynamic Gait Index, functional reach, Falls Efficacy scale, 10-m walk test, Fatigue Severity Scale, Beck Depression Inventory, and Short Form 36 scores, were assessed initially and at 8 wks. Results:After dropouts, the whole study group consisted of 20 women and 13 men (mean age, 37.9 ± 10.43 yrs). In training group 1, duration of exercise, tolerated maximum workload, timed up and go test, Dynamic Gait Index, functional reach, falls efficacy scale, 10-m walk test, Fatigue Severity scale, and Beck Depression Inventory scores, and in group 2, the mean duration of exercise, tolerated maximum workload, and Falls Efficacy scale scores were significantly improved after the training program (P < 0.05). There were no significant improvements in any of the outcome measurements in the control group (P > 0.05). In between-group comparisons, improvements in outcome measures of group 1 patients were significantly higher than those in other groups, except for 10-m walking test. Group 1 patients showed statistically significant improvement in physical functioning and role-physical functioning scales of the Short Form 36 (P < 0.01 and P < 0.05, respectively), and group 2 patients showed statistically significant improvement in only physical functioning scale of Short Form 36 (P < 0.05) after 8 wks. Conclusions:Specific exercise programs, including cycling progressive resistance training, may improve balance, fatigue, and depression and reduce fear of falling in patients with multiple sclerosis without worsening multiple sclerosis signs and symptoms.

Seronegative spondyloarthropathy of familial Mediterranean fever.

Abstract. Familial Mediterranean fever (FMF) is characterized by an autosomal inheritance pattern, Mediterranean ancestry, and history of recurrent fever. We present a 30-year-old Turkish man with FMF and accompanying seronegative spondyloarthropathy. His diagnose depended on the clinical course of his disease: recurrent fever accompanied by abdominal pain attacks together with a positive family history and his ethnic origin and sacroiliitis. We review the common manifestations of FMF and remind physicians that sacroiliac joint involvement must be kept in mind in presence of articular symptoms in a FMF patient.

Complex regional pain syndrome type-I after rubella vaccine

Complex regional pain syndrome type I (CRPS‐I) is a complex disorder characterised by pain, autonomic dysfunction, and decreased range of motion. The syndrome was believed as a well‐recognized disorder in adults but, less commonly recognized in children. CRPS‐I after vaccination has been rarely reported. We reported an 11‐year‐old young girl with CRPS‐I due to rubella vaccine.

The Efficacy of Gabapentin in Patients with Failed Back Surgery: A Prospective Case Series

Objective: Failed back surgery syndrome [FBSS] causes persistent low back problems in approximately 15 percent of patients who undergo spinal surgery for lumbar disc herniation. As reported by recent clinical data, gabapentin, an antiepileptic agent, is increasingly being used for chronic pain, with a favorable side effect profile. The aim of this study was to investigate the efficacy of gabapentin in patients with FBSS associated chronic back pain Methods: Nine patients with chronic back pain diagnosed with FBSS according to clinical, lumbar spinal magnetic resonance imaging and electrodiagnostic findings were studied. Each patient received titrated dosage of gabapentin from 900 to 2400 mg/day. Pretreatment levels of pain and the degree of disability were measured using a visual analog scale and the Oswestry disability index. All nine patients were re-evaluated at six weeks and six months Results: Eight of nine patients reported significant decrease in pain and disability scores at six weeks and six months after treatment. One patient who underwent spinal surgery five times did not report benefit from gabapentin. Gabapentin was well tolerated and there were no significant side effects Conclusion: Our results indicate that gabapentin monotherapy may be an effective adjunct for the treatment of FBSS associated chronic low back pain.

Coexisting seronegative rheumatoid arthritis and ankylosing spondylitis

The coexistence of rheumatoid arthritis (RA) and ankylosing spondylitis (AS) in the same patient is a phenomenon that has been only rarely reported [1]. The coexistence of seronegative rheumatoid factor (RF) is unusual. We here report a female patient who satisfied the diagnostic criteria for both AS and seronegative RA. A 62-year-old woman with a 10-year diagnosis of seronegative RA was admitted to hospital because of increased disease activity. She had bilateral pain and limited range of motion in her finger, wrist, elbow, shoulder, hip and knee joints, and swelling in her right knee with morning stiffness that lasted for more than an hour. There was no family history of any arthritic disorders or any form of spondylarthropathy. She denied any history of psoriasis, urethritis, iritis or symptoms suggestive of inflammatory bowel disease (IBD). Examination revealed symmetrical synovial thickening of the wrists, metacarphophalangeal and proximal interphalangeal joints. Spinal movement was restricted in all planes. Ritchie articular score was 40 and Stoke index showed severe inflammatory activity. Psoriasis, subclinical gout inflammation, IBD and crystal-induced arthropathy such as CPPD were excluded by laboratory and clinical examinations. Keratoconjunctivitis sicca and pulmonary involvement consistent with RA were found as extra-articular findings by consultant specialists. Laboratory results were as follows: erythrocyte sedimentation rate 77 mm/h, C-reactive protein 95.7 mg/dl and RF negative. Histocompatibility locus antigen (HLA) testing demonstrated the presence of HLA B27, but HLA DR4 was not present. Radiographs revealed bilateral erosive arthritis of the hands and wrists, bilateral symmetrical narrowing of the sacroiliac joint space, and bony sclerosis and syndesmophyte formation in the lumbosacral spine (Fig. 1). CT scans of the sacroiliac joint revealed bilateral grade III sacroiliitis. Pulmonary high-resolution CT showed linear fibrotic changes in the left upper lobe and a reticulonodular pattern in the lung bases. Pulmonary function tests showed a restrictive pattern. We suspected coexisting seronegative RA and AS because of the patient s marked limitation of lumbar

The Effects of Local Steroid Injection on Pain, Disability, and Hand Functions in Patients with Lateral Epicondylitis

ABSTRACT Objectives: To evaluate the pain intensity, disability, and hand functions in patients with chronic lateral epicondylitis and to determine the short- and long-term effects of steroid injection on pain, disability, and impaired hand function. Methods: Patients with chronic unilateral lateral epicondylitis and healthy normal controls [HNC] matched for age, body mass index [BMI], and hand dominancy were included. A pain questionnaire was used to determine the subjective pain and disability caused by lateral epicondylitis. Pressure pain thresholds [PPTs] on the lateral epicondyles of both patients and HNCs were measured with a pressure pain algometer. Isometric hand grip strength measurements were performed with a Jamar hand dynamometer, and lateral pinch grip strength measurements were performed with a pinchmeter. The mixture of 20 mg of methylprednisolone and 0.5 ml of prilocaine at two percent was injected deep into the subcutaneous tissues and muscles 1cm distal to the lateral epicondyle. Pain questionnaire, grip strength, lateral pinch, and PPT measurements were repeated at two weeks and three months after steroid injection. Results: Sixty lateral epicondylitis patients and 30 HNCs participated. Compared with HNCs, patients with lateral epicondylitis had significantly increased pain and disability scores and decreased isometric hand grip strength and lateral pinch grip strength [p < .001]. Pain questionnaire scores of the patients showed statistically significant decrease, and isometric hand grip strength, lateral pinch grip strength, and PPTs showed statistically significant increase [p < .01] at the second week after injection. In all parameters, significant improvement was also observed at the third month after injection [p < .001]. Conclusion: Steroid injection is effective on pain, disability, and impaired hand functions with both its short- and long-term benefits in patients with lateral epicondylitis.

Anomalous Innervation of the Intrinsic Hand Muscles in a Patient with Carpal Tunnel Syndrome

ABSTRACT Background: Communications between the median and ulnar nerves in the hand provide for variations in the motor innervation of the intrinsic hand muscles. The presence of an anomalous communication may complicate the interpretation of electrodiagnostic findings. Findings: We reported here a 56-year-old woman; her thenar muscles had been spared by ulnar-to-median anastomosis despite severe carpal tunnel syndrome. Conclusions: The presence of the ulnar-to-median anastomosis may complicate the interpretation of electrodiagnostic findings. Clinicians should be aware of this possibility, especially in the presence of paradoxical clinical and electrodiagnostic findings.

Relationship between high-resolution computed tomography findings and the Stoke index in patients with rheumatoid arthritis

The aim of this study was to evaluate the relationship between high-resolution computed tomography (HRCT) findings and the Stoke index (SI) in patients with rheumatoid arthritis (RA). Forty RA patients (31 women, 9 men) were evaluated. All patients fulfilled the criteria proposed by the American College of Rheumatology. Clinical evaluation, haematological data, chest radiography, pulmonary function tests (PFTs) and HRCT were obtained in all patients. The SI was used to assess disease activity. In 17 (42.5%) patients, there were no signs of pulmonary involvement on HRCT; 23 (57.5%) of 40 patients had abnormal HRCT findings. Of 23 patients with HRCT abnormalities, six (two male, four female) had respiratory symptoms, four (one male, three female) had abnormalities on chest radiography and five (all female) had abnormalities on PFTs. There was no relationship between pulmonary changes observed on HRCT, clinical and laboratory disease activity parameters, chest X-ray and PFTs. There was no difference in the mean SI between patients included in the HRCT (+) and those included in the HRCT (-) groups. No significant correlations between the HRCT and the SI were seen. The main findings of this study are that HRCT can give useful information on RA-associated lung changes and that there was no relationship between the SI and the HRCT findings of patients with RA.