Mustafa Unal

Psychiatric symptoms in ankylosing spondylitis: their relationship with disease activity, functional capacity, pain and fatigue

OBJECTIVES The aim of this study is to evaluate psychiatric symptoms in patients with ankylosing spondylitis (AS) and to investigate the relationship of the disease activity, functional capacity, pain, and fatigue with psychiatric symptoms. METHODS Eighty AS patients and 80 healthy controls were included in the study. Spinal pain by visual analog scale (pain VAS-rest), disease activity by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), functional capacity by Bath Ankylosing Spondylitis Functional Index (BASFI), and fatigue by Multidimensional Assessment of Fatigue (MAF) were assessed in patients. Psychiatric symptoms were measured using the Symptom Checklist-90-R (SCL-90 R), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Pittsburgh Sleep Quality Index (PSQI) and Rosenberg Self-Esteem Scale (RSES). RESULTS SCL-90-R total and all subscale scores (except interpersonal sensitivity and psychoticism) and BDI scores were significantly higher in the AS group compared to control group. PSQI total and all subscale scores were significantly higher in the AS group. State anxiety scale score was significantly higher and RSES score was significantly lower in the AS group. Psychiatric symptoms (except Rosenberg Self-Esteem score) were significantly correlated with BASDAI, BASFI, pain VAS rest, and MAF scores. CONCLUSION Psychiatric symptoms are often seen in patients with AS. Disease activity, functional capacity, pain and fatigue were correlated with psychiatric symptoms but self-esteem was not. Therefore, psychiatric symptoms should be taken into consideration in the management of AS.

How effective is a modified exercise program on its own or with back school in chronic low back pain? A randomized-controlled clinical trial

BACKGROUND AND OBJECTIVES The aim of this trial is to search effectiveness of specifically adapted exercise programs on its own and with low back school on pain, disability, trunk and quadriceps muscle strength, walking performance, spinal mobility, quality of life (QOL), and depression in the patients with chronic low back pain (CLBP). MATERIAL AND METHOD A total of 121 patients with definite CLBP were included in this study. The patients were randomized into two groups. Group 1 (n=60) was given exercises only and accepted as the control group. Group 2 (n=61) received back school program and exercises. The exercise treatment was performed 3 days a week, for 3 months. The pain (visual analog scale, VAS), disability (Oswestry Disability Questionnaire, ODQ), walking performance (6 minute walking test, 6MWT), depression (Beck Depression Inventory scores, BDI), and QOL (Short Form 36, SF-36) of all participants were evaluated. The trunk and knee muscle strength were measured with a handheld dynamometer. Patients were assessed at baseline (BT), at the end of treatment (AT), and at the six month follow-up (F). RESULTS Statistically significant improvements were found between groups regarding all of the clinical parameters over time. Pain, disability, muscle strength, endurance, 6MWT, mobility, QOL, and depression of both groups also showed improvements AT. These improvements persisted at 6-months follow-ups (P < 0.05). There were statistically significant differences between the groups for pain, disability, muscle strength, endurance, 6MWT, QOL, and depression regarding the change scores between AT-BT test and F-BT test (P < 0.05). Group 2 improved more than group 1 except for mobility. CONCLUSION Exercise programs can be modified and used successfully in CLBP and this effect can be increased with addition of back school further. LEVEL OF EVIDENCE Diagnostic study Level-I-I (prospective study).

Four Patients With Different Characteristics in Smoking and Cessation-Case Series

Smoking is one of the worst habits adversely affect health. Various reasons can play a part in starting smoking. Addictions are difficult to combat for various reasons. In our manuscript, four patients with different characteristics in smoking and cessation were presented. Sigara, sagliga olumsuz etkide bulunan en kotu aliskanliklardandir. Sigaraya baslama nedenleri cok cesitli olabilmektedir. Bagimliliklarla cesitli nedenlerle mucadele edilmesi zordur. Makalemizde, sigarayi icme ve birakma konusunda farkli ozellikte dort hasta sunulmustur.

DOES SELF-CONTROL MEAN EVERYTHING FOR SMOKING CESSATION? -

Rutin kontrol amaciyla aile sagligi merkezine basvuran, esansiyel hipertansiyon tanisi ile takip edilen 58 yasindaki erkek hastaya sigara icip icmedigi soruldu. Hasta 18-53 yaslari arasinda gunde 4 paket (140 paket/yil) sigara ictigini, son 5 yildir sigara icmedigini belirtti. Sigarayi birakma kararini bir anda verdigi, herhangi bir tibbi veya alternatif/ tamamlayici tibbi oneri almadigi ogrenildi. Bu karari aldigi gunku dis etken olarak, yaptiklari bir ev ziyareti esnasinda ev sahibinin, yemekten sonra sigara icen hastamiza yonelttigi sigara icmesi ile ilgili kirici sozler oldugu not edildi. Hastamizin, oldukca yogun sigara icme gecmisine ragmen, tibbi destek almadan sadece iradesiyle sigarayi birakmasinin sasirtici oldugu dusunuldu. Her ne kadar sigarayi birakmada kisinin karari ve bu konudaki tutum, davranislari belirleyici rol aliyorsa da, bu surecin profesyonelce yonetilmesi ve gerektigi durumlarda farmakoterapi uygulanmasi basarili bir sigara birakma sureci icin gereklidir.

Diz Osteoartritinde Kapsaisin Fonoforezin Etkisi ve Birinci Basamakta Erken Kullanılabilirliği: Randomize Kontrollü Bir Çalısma

Amac: Bu calismanin amaci Kapsaisin fonoforezis ve kapsaisin jelin diz osteoartritinin tedavisinde agri, engellilik, fonsiyonalite, uyku kalitesi ve depresyon uzerine etkilerini degerlendirmektir. Gerec ve Yontem: Yetmis uc hasta 3 gruba ayrildi. Tum gruplara egsersiz tedavisi uygulandi. Egsersize ek olarak birinci gruba (n = 24) kapsaisin fonoforezis, ikinci guruba (n = 24) kapsaisin jel uygulandi. Tedaviler haftada 3 gun, 6 hafta uygulandi. Hastalar agri icin gorsel analog skala, engellilik icin Western Ontario ve McMaster Universite Osteoartrit Indeksi, fonksiyon icin 50 m yurume zamani, depresyon icin Beck Depresyon Skalasi ve uyku kalitesi icin Pittsburgh Uyku Kalite indeksi ile degerlendirildi. Degerlendirilmeler tedavi sonrasi ve 1 aylik izlemde yapildi. Bulgular: Tum guruplar tum parametrelerde iyilesme gosterdi. Agri skor sonuclari grup 1 de daha iyi idi. Bu iyilik bir ay izleminde hala devam ediyordu. Grup 1 ve 2 arasinda engellilik, fonksiyon, depresyon ve uyku kalitesi acisindan fark bulunmadi. Sonuc: Kapsaisin fonoferezis agriyi azaltmada egsersiz ve kapsaicin jele gore daha etkilidir. Kapsaisin jelin haftada sadece 3 defa kullanilmasina ragmen fonksiyon, engellilik ve uyku kalitesi uzerine capsaisin fonoferesiz kadar etkili oldugu ve ayni zamanda egsersizin uyku kaliesi ve fonksiyon uzerine etkisini artirdigi gosterildi. Bu sonuc ozellikle birinci basamakta kapsaicin jel kullanimini tesvik etmektedir.Aim: The aim of this study is to evaluate the effect of capsaicin phonophoresis (PP) and capsaicin gel in the treatment of knee osteoarthritis (OA) on scores of pain, disability, functionality, sleep quality and depression. Method: Seventy-three patients divided into 3 groups. All groups receieved exercise therapy. Addition to exercise, group 1 (n = 24) received capsaicin PP, Group 2 (n = 24) capsaicin gel. Therapies applied 3 days a week, for 6 weeks. Patients were evaluated with visual analogue scale (VAS) for pain, Western Ontario and McMaster University Osteoarthritis Index for disability, 50-m walking time for functionality, Beck Depression Inventory Scores for depression and Pittsburgh Sleep Quality Index for sleep quality. Evaluations are done after the therapy, and at 1month follow up. Results: All groups improved significantly in all parameters. Pain scores after treatment were better in group 1. Regarding pain scores at follow up it was still effective. Regarding disability, functionality, depression and sleep quality no difference found between group 1 and 2. Conclusion: Capsaicin Phonophoresis is more effective in reducing pain compared to exercise and capsaicin gel. Capsaicin gell was as effective as Capsaicin Phonophoresis on functionality, disability and sleep quality and also more effective than exercise alone on functionality and sleep despite using 3 times a week. This result encourages capsicin gel usage in the treatment of knee osteoarthritis especially in primary care.

Science Fiction or Fictional Science in Medical Education

We designed a class titled “Medicine in Science Fiction” in the Medicine in the Future selective rotation (for 3 weeks) of 40 first-year students at the Ondokuz Mayis University Medical Faculty. This class consisted of presentations, discussion sessions and a group project. Students attended active presentations enriched by various clips from science-fiction movies. These were selected based on their scientific value, questioning important ethical problems or challenging the development of technology, or just because they are popular. In the discussion sessions students evaluated these clips in terms of whether they are logical, whether or not they conflict with the general laws of science, and whether they are compatible with daily medical procedures or ethical principles. Finally, the students prepared group presentations concerning a science fictional medical technology and the obstacles (scientific or ethical problems, etc.) to this being developed today. The first group’s project concerned the medical ‘tricorder’ in Star Trek, second group’s was about biological autograft (stem cell) or mechanical prosthetic limp technology and the third group’s was about nanotechnology.

A Patient Having Recurrent Aphtous Stomatitis After Three Years of Smoking Cessation

Cigarette smoking is the foremost health risk issue affecting individuals of all age groups globally. It is the most important causes of the preventable deaths and diseases. Aware of these facts many smokers wish to quit. However smoking cessation is though for smokers who experiences many unpleasant and troublesome physiological or psychological problems. After cessation oral ulcers and other oral aphtous lesions which are considered as mild and expected to disappear in time, can be seen. These problems are attributed with either nicotine withdrawal or nicotine replacement therapy. Recurrent oral aphtous stomatitis however can be very severe and diminish quality of life even some years after cessation. There are growing epidemiologic evidences for the effects of tobacco use and tobacco cessation therapy on a variety of oral diseases and conditions. In this case report we would like to introduce an ex-smoker patient who had severe recurrent aphtous stomatitis attacks for three years after he had quitted and the current data about the management of oral ulcers and aphtous stomatitis.

SAT0427 How Effective a Modified Exercise Program on its Own or with Back School in Chronic Low Back Pain? A Randomized-Controlled Clinical Trial

Background Chronic low back pain (CLBP) is seen frequently in all societies of the world that causes significant loss of working days. Many treatment modalities have been proposed for its treatment. Objectives The aim of this trial is to search effectiveness of specifically adopted exercise programs on its own and with low back school on pain, disability, trunk and quadriceps muscle strength, walking performance, spinal mobility, quality of life (QOL), and depression in the patients with CLBP. Methods A total of 121 patients with definite CLBP were included in this study. The patients were randomized into two groups. Group 1 (n = 60) was given exercises only and accepted as the control group. Group 2 (n = 61) received back school program and exercises. The exercise treatment was performed 3 days a week, for 3 months. The pain (visual analog scale, VAS), disability (Oswestry Disability Questionnaire, ODQ), walking performance (6 minute walking test, 6MWT), depression (Beck Depression Inventory scores, BDI), and QOL (Short Form 36, SF-36) of all participants were evaluated. The trunk and knee muscle strength were measured with a handheld dynamometer. Patients were assessed at baseline (BT), at the end of treatment (AT), and at the six month follow-up (F). Results Statistically significant improvements were found between groups regarding all of the clinical parameters over time. Pain, disability, muscle strength, endurance, 6MWT, mobility, QOL, and depression of both groups also showed improvements AT. These improvements persisted at 6-months follow-ups (P < 0.05). There were statistically significant differences between the groups for pain, disability, muscle strength, endurance, 6MWT, QOL, and depression regarding the change scores between AT–BT test and F–BT test (P < 0.05). Group 2 fared better than group 1 except for mobility. Conclusions Exercise programs can be modified and used successfully in CLBP and this effect can be increased with addition of back school further. Disclosure of Interest None Declared