Nebahat Sezer

Chronic complications of spinal cord injury

Spinal cord injury (SCI) is a serious medical condition that causes functional, psychological and socioeconomic disorder. Therefore, patients with SCI experience significant impairments in various aspects of their life. The goals of rehabilitation and other treatment approaches in SCI are to improve functional level, decrease secondary morbidity and enhance health-related quality of life. Acute and long-term secondary medical complications are common in patients with SCI. However, chronic complications especially further negatively impact on patients functional independence and quality of life. Therefore, prevention, early diagnosis and treatment of chronic secondary complications in patients with SCI is critical for limiting these complications, improving survival, community participation and health-related quality of life. The management of secondary chronic complications of SCI is also important for SCI specialists, families and caregivers as well as patients. In this paper, we review data about common secondary long-term complications after SCI, including respiratory complications, cardiovascular complications, urinary and bowel complications, spasticity, pain syndromes, pressure ulcers, osteoporosis and bone fractures. The purpose of this review is to provide an overview of risk factors, signs, symptoms, prevention and treatment approaches for secondary long-term complications in patients with SCI.

Low-frequency pulsed electromagnetic field therapy in fibromyalgia: a randomized, double-blind, sham-controlled clinical study.

ObjectiveTo evaluate the clinical effectiveness of low-frequency pulsed electromagnetic field (PEMF) therapy for women with fibromyalgia (FM). MethodsFifty-six women with FM, aged 18 to 60 years, were randomly assigned to either PEMF or sham therapy. Both the PEMF group (n=28) and the sham group (n=28) participated in therapy, 30 minutes per session, twice a day for 3 weeks. Treatment outcomes were assessed by the fibromyalgia Impact questionnaire (FIQ), visual analog scale (VAS), patient global assessment of response to therapy, Beck Depression Inventory (BDI), and Short-Form 36 health survey (SF-36), after treatment (at 4u2009wk) and follow-up (at 12u2009wk). ResultsThe PEMF group showed significant improvements in FIQ, VAS pain, BDI score, and SF-36 scale in all domains at the end of therapy. These improvements in FIQ, VAS pain, and SF-36 pain score during follow-up. The sham group also showed improvement were maintained on all outcome measures except total FIQ scores after treatment. At 12 weeks follow-up, only improvements in the BDI and SF-36 scores were present in the sham group. ConclusionLow-frequency PEMF therapy might improve function, pain, fatigue, and global status in FM patients.

Adult case of acrodysostosis with severe neurologic involvement

OBJECTIVEnAcrodysostosis is a rare syndrome characterized by peripheral dysostosis, nasal hypoplasia and frequently mental retardation. Only one adult case of acrodysostosis has been reported to have neurologic symptoms. We report one further adult case of acrodysostosis with severe neurologic findings including myelopathy and spastic paraparesis due to diffuse spinal stenosis and recurrent deep vein thrombosis possibly caused by neurologic deficits.nnnRESULTSnWe report a 43-year-old woman who had back and neck pain with weakness in the extremities of several years. 1~year before admission to our hospital, she had been treated with a missed diagnosis of sero (-) spondyloarthropathy but had not benefited. She became unable to walk, thereafter she underwent decompression surgery with a diagnosis of degenerative spinal stenosis. She presented at our outpatient department complaining of lowback pain and difficulty walking. She had marked facial and peripheral appearance of acrodysostosis. Spinal MRI revealed extensive spinal stenosis. A diagnosis was made through the genetic investigation, clinical and radiological findings. Spastic paraparesis were detected. There was widespread neuropathic pain. 15 days after admission, she developed swelling and redness of the left lower extremity and the venous doppler ultrasonography showed left acute and right past DVT. We treated DVT with anticoagulant therapy. Gabapentin and Baclofen were initiated for neuropathic pain and spasticity. A conventional rehabilitation program was performed. She left walking with a walker without pain and spasticity.nnnCONCLUSIONSnWe would like to remind physicians to be aware of peripheral malformations as signs of skeletal dysplasias and to consider acrodysostosis in the differential diagnosis. Although it is a rare condition, if diagnosed early, possible complications can be treated and outcomes may be improved.

Dynamic Thiol/Disulphide Homeostasis in Patients With Fibromyalgia

ObjectivesnThis study aims to investigate dynamic thiol/disulphide homeostasis in patients with fibromyalgia syndrome (FMS).nnnPatients and methodsnFifty female patients with FMS (mean age 40.5±7.2 years; range 21 to 55 years) and 40 healthy female controls (mean age 39±9.4 years, range 22 to 55 years) were included in the study. Pain visual analog scale, tender points, Fibromyalgia Impact Questionnaire, and Beck Depression Inventory were evaluated. Age, body mass index (BMI), and symptom durations were also recorded. Native thiol, disulphide and total thiol levels were measured with a novel automated method.nnnResultsnSerum disulphide levels were 14.7±3.4 μmol/L and 22.2±3.6 μmol/L in the FMS and control groups, respectively (p<0.001). Native thiol levels were 452.1±33.8 μmol/L and 433.5±37.6 μmol/L in the FMS and control groups, (p=0.015), while total thiol levels were 481.7±35.6 μmol/L and 477.5±38.9 μmol/L in the FMS and control groups, respectively (p=0.593). In the FMS group, disulphide/native thiol percent ratios and disulphide/ total thiol percent ratios were statistically significantly lower and native/total thiol percent ratios were statistically significantly higher than those of the control group. There were no correlations between serum thiol/disulphide profiles and pain scores & clinical variables in patients with FMS.nnnConclusionnBecause of the decreased disulphide and increased native thiol levels, the thiol/disulphide balance has shifted to the reductive side. This metabolic disturbance may have a role in the pathogenesis of FMS.

Gabapentin-Induced Urinary Incontinence: A Rare Side Effect in Patients with Neuropathic Pain

Gabapentin is a first-line agent for neuropathic pain management and has a favorable safety profile. The literature includes a few cases of gabapentin-induced incontinence, and most of them involved patients with epilepsy who were between the ages of 12 and 43 years. Herein, we present three patients with neuropathic pain due to different diagnoses, and, to our knowledge, these are the oldest reported cases of urinary incontinence caused by gabapentin therapy. A 56-year-old female patient who underwent hip arthroplasty developed a sciatic nerve injury and neuropathic pain postoperatively. Ten days after she began taking gabapentin to relieve her pain, she experienced daily urinary incontinence. In another instance, a 63-year-old female patient was diagnosed with complex regional pain syndrome, and seven days after the initiation of gabapentin therapy, urinary incontinence developed. In addition, a 66-year-old male patient with neuropathic pain due to cervical disc pathology complained of urinary incontinence after the onset of gabapentin therapy. After discontinuing this drug, the incontinence symptoms resolved in these patients on the seventh, the first, and the second days, respectively. Physicians who administer gabapentin should inform their patients about the potential risk of gabapentin-induced incontinence and its negative impact on quality of life.

Effect of Illness Perception on the Quality of Life in Ankylosing Spondylitis

Amac: Ankilozan Spondilit (AS), karakteristik olarak sakroiliak eklemleri, omurga ve periferik eklemleri, bagirsaklari ve gozleri etkileyebilen, kronik, inflamatuvar romatizmal ilerleyici bir hastaliktir. ASnin klinik bulgulari iyi bilinmekte ancak hastaligin, etkilenen kisinin subjektif sagligi uzerindeki etkileri yeterince bilinmemektedir. Bu calismanin amaci Ankilozan Sondilitli (AS) hastalarda hastalik algisini, hastalik aktivitesini, fonksiyonel ve emosyonel durumunu ve bunlarin hastalik aktivitesi ile iliskisini degerlendirmektir. Materyal ve Metot: Altmisyedi AS’li hasta calismaya katildi. Hastalikla ilgili yasam kalitesi Ankilozan Spondilit Yasam Kalitesi Indeksi (ASQoL) ve hastalik algisi Kisa Hastalik Algi Olcegi ile degerlendirildi. Hastalik aktivitesi ve fonksiyonel kapasitesi, Bath Ankilozan Spondilit Hastalik Aktivite Indeksi (BASDAI), Bath Ankilozan Spondilit Fonksiyonel Indeksi (BASFI) ile degerlendirildi. Psikolojik durumun degerlendirmesinde Beck Depresyon Olcegi kullanildi. Bulgular: Sonuclarimiza gore, hastalik algisi ile yasam kalitesi arasinda anlamli iliski bulunmustur. Bununla birlikte, yasam kalitesini en cok etkileyen faktorler fonksiyonel durum ve yasam kalitesidir. Sonuc: Rutin klinik uygulamada hastalik algisinin degerlendirilmesi, hastanin davranislarinda tedaviye uyuma engel olabilecek sorunlarin daha iyi anlasilmasina katkida bulunabilir. Konvansiyonel terapiyeek olarak psikoterapotik yaklasimlar, ASde hastalarin yasam kalitesini iyilestirmede katkida bulunabilir.

The prevalence and risk factors for osteoporosis among 18- to 49-year-old Turkish women

ABSTRACT The aim of this study was to determine the prevalence of osteoporosis and associated risk factors in Turkish women aged 18–49 years. A population-based, cross-sectional study was conducted between January and April 2014. The sample (n = 1,792) was comprised of women aged 18–49 years, who resided in Cubuk, Ankara, Turkey, and were selected by simple random sampling. The data were collected in face-to-face interviews using an Individual Information Form and an Osteoporosis Risk Estimation Scale. Bone mineral density was assessed using standard dual-energy X-ray absorptiometry. Multiple logistic regression and chi-square analyses were used for analyses. Most participants (80.1%) were at low risk of developing osteoporosis, while 6.9% were at medium to high risk of developing the disease. From bone mineral density levels, 33.3% were osteopenic; 4.0% were osteoporotic; 33.3% were osteopenic at the femoral neck; and 6.7% were osteoporotic at the lumbar vertebra L1−L4. Further, results of multiple logistic regression analyses showed that osteoporosis risk was significantly associated with smoking, having light skin, multiparity, and having a family history of osteoporosis (p < .05). These results indicated that public health screening strategies for protecting women’s bone health at earlier ages than previously thought might be beneficial.

An Unusual Cause of Myelopathy: Ochronotic Spondyloarthropathy with Positive HLA B27.

Ochronosis is a late developing complication of alkaptonuria, a black brownish pigment in the fibrous and cartilaginous tissues. Although most previous studies reported alkaptonuria and back pain due to ochronosis, thoracic myelopathy is an extremely rare complication. In this report, a paraparetic patient who has ochronotic spondiloarthropathy with the presence of HLA B27 antigen is described. He had low back and leg pain and morning stiffness for 5 yrs. Last year, these were followed by tingling, numbness, and weakness the in lower extremities and he was operated on with preliminary diagnosis of prolapsed disc herniation and cord compression. Surgery is suggested for disc herniations related to ochronotic spondyloarthropathy if it is necessary or neurologic symptoms are present. However, his pain and weakness have partially recovered after the operation. After medical and physical treatment, he showed clinically significant improvements. This case report demonstrates that the management of ochronosis needs a multidisciplinary approach with physiologic, neurologic, and psychologic effects and proper treatment may significantly improve functional outcomes in these patients.