Oya Özdemir

Quality of life in patients with ankylosing spondylitis: relationships with spinal mobility, disease activity and functional status

The aim of this study was to evaluate quality of life (QOL) in patients with ankylosing spondylitis (AS) and to determine the relationships between QOL and clinical variables including spinal mobility, disease activity and functional status. Forty-eight adult patients who fulfilled the modified New York criteria for AS were included in the study. After detailed physical examination, disease-specific instruments: the Bath ankylosing spondylitis disease activity index (BASDAI) and the Bath ankylosing spondylitis functional index (BASFI) were applied. QOL was assessed using short form-36 (SF-36). The mean age of the patients was 37.0 ± 9.7 years and the mean duration of symptoms was 11.7 ± 8.4 years. Most affected domains of SF-36 were bodily pain, vitality, and physical role, respectively. No significant correlations were found between SF-36 subgroup scores and chest expansion, wall-tragus distance, chin-sternum distance, and floor-finger tip distance. Only modified Schober correlated with two SF-36 domains: physical role and bodily pain. BASDAI and BASFI scores had significant negative correlations with all SF-36 domains except for general health. Identification of QOL in patients with AS is very important in evaluation of illness-related sufferings and development of new management strategies.

Spontaneous unilateral accessory nerve palsy: a case report and review of the literature

Isolated spinal accessory nerve (SAN) palsy is a well-recognized complication of surgical prodecures in the posterior triangle of the neck. Various rare etiological factors were also described. Whatever the etiology, the typical clinical features of SAN palsy can be listed as atrophy/weakness of the trapezius muscle and moderate winging of the scapula. It is imperative to promptly diagnose this condition in the early stage to avoid long-term impairment and to have a better functional outcome. Herein, we present a patient with a diagnosis of spontaneous spinal accessory nerve palsy, which was rarely reported in the relevant literature.

Interleukin-1, -6, and -8 levels in juvenile chronic arthritis.

SummaryThe immunoinflammatory pathogenesis of juvenile chronic arthritis (JCA) involves the activation of many pathways including various cytokines. We have evaluated the levels of interleukin (IL)-1, IL-6 and IL-8 in 29 JCA patients. The age range was 1–16 with a mean of 10.1. A disease activity score was developed on the basis of: 1.constitutional symptoms and/or morning stiffness, 2.presence of joint swelling, 3.warmth, 4.limited range of motion, and 5.joint pain. This score correlated very significantly with laboratory disease activity markers such as erythrocyte sedimentation rate (ESR) and CRP (both p=0.006) and also correlated with IL-1 and IL-6 levels. The levels of IL-1 decreased in four of the five patients with improved disease activity. IL-6 but not IL-1 correlated significantly with the number of inflamed joints (p=0.013); IL-6 also strongly correlated with rheumatoid factor supporting this cytokines role in B cell induction (p=0). Haemoglobin values correlated negatively with the activity index, ESR, CRP, IL-1 and IL-6. IL-8 did not correlate with disease activity markers. In the systemic patients all cytokines tended to be higher. Our data suggest that interleukins 1 and 6 are effective in the pathogenesis of JCA. Whether cytokines may be used for monitoring therapy may be clarified with further studies.

The frequency of fibromyalgia in sport professionals

Fibromyalgia is a chronic musculoskeletal disorder characterized by widespread pain and tenderness at specific anatomic sites, commonly accompanied by fatigue [1]. The etiopathogenesis of fibromyalgia is probably multifactorial and peripheral, and central factors are thought to interact with the development of this syndrome. The true incidence and prevalence of fibromyalgia is unknown. However, studies from North America and Europe have revealed overall prevalence rates ranging from 1 to 5% in the general population [2]. It is well known that many individuals with fibromyalgia are typically inactive and deconditioned [3, 4]. Thus, various forms of exercises are increasingly recommended to these patients as an integral part of nonpharmacological treatment. Aerobic and muscle strengthening exercises are shown to be effective at improving symptoms, tender point counts, pain threshold, physical fitness and quality in fibromyalgia [5]. Professional athletes regularly perform exercise programs designed to improve and maintain their physical fitness. Therefore, it can be expected that the prevalence of fibromyalgia in adults participating in competitive sports is to be lower than that in general population. The aim of this study was to determine the frequency of fibromyalgia in a population of sport professionals. One hundred and eighty-five sport professionals (74 women, 111 men) were enrolled in the study. Each of the participants was asked whether he or she had widespread pain over the last 3 months. If the answer was yes, then the duration and severity of pain were recorded. In the physical examination, 18 tender points identified by the 1990 American College of Rheumatology (ACR) criteria for the diagnosis of fibromyalgia were palpated, and the subjects’ responses were noted. Statistical analyses were performed by using the SPSS version 11.5 for Windows package program. Results were expressed as mean ± standard deviation. Mann–Whitney U test was used for comparison of the duration and severity of pain. Statistical significance was determined at P value \ 0.05. Fifty-nine participants (64.4% of them were men) with a mean age of 23.9 ± 4.9 years had declared that they have widespread pain. The mean duration of pain was 37.8 ± 39.3 (median 24) months. The mean value of pain severity marked on a 10-cm visual analog scale was 42.5 ± 21.2 mm. There were no significant differences between genders in the duration and severity of widespread pain. Six of the individuals with widespread pain had no tender points, whereas the average number in the ones who had at least one tender point was 5.5 ± 3.7 (1–18). Eleven or more of the 18 tender points were detected in 12 subjects. However, only 4 of them suffered from widespread pain and diagnosed with fibromyalgia. To the best of our knowledge, only one study has been previously conducted to determine the prevalence of fibromyalgia in young healthy athletes. Andary et al. evaluated 641 college student athletes and found that only F. _ Inanici O. Ozdemir Y. G. Kutsal Z. Hascelik Department of Physical Medicine and Rehabilitation, Hacettepe University Medical School, Ankara, Turkey

Hiv infection and shoulder pain : a challenging case

With better understanding of the pathogenesis of AIDS and the advent of anti-retroviral medications, patients with HIV are living longer and the probability that they will suffer musculoskeletal complications are increasing. There is a vast array of musculoskeletal impairments including rheumatologic, infectious, and non-infectious conditions. We report a 53-year-old man with longstanding shoulder pain, weakness, and spasticity of the upper extremity which was diagnosed as adhesive capsulitis secondary to brain abscess. Musculoskeletal problems may be complicated with neurological involvement as in our case and patients should be investigated for possible underlying life-threatening disease.

The relationship between body mass index and footprint parameters in older people

BACKGROUND The relationship of body mass index (BMI) with footprint parameters has been studied in paediatric populations, but there are limited data regarding the effects of BMI on parameters in the elderly. OBJECTIVES To establish the relationship between BMI and static footprint parameters in the elderly population. METHODS 128 subjects aged 65 and above with no history of lower extremity surgical intervention and no significant lower extremity weakness were included in the current study. BMI and footprint parameters of arch angle, Chippaux-Smirak index (CSI), Staheli index (SI), arch index (AI) and footprint index (FI) were measured for each subject, and statistical analysis was done to investigate the correlation between BMI and the parameters. RESULTS Weak correlations detected between all calculated indices and angles with BMI, except the left foot arch angle. CSI, SI and AI of the right foot were found to be positively correlated with BMI, while a negative correlation between the arch angle and FI of right foot was shown with BMI. CONCLUSIONS The results reveal a relationship between BMI and footprint parameters that are indicative of flatfoot in the elderly. This could be due either to confounding of the footprint measure by fat or possibly due to an as yet unknown structural change that requires further evaluation.

Thoracic outlet syndrome : another cause for unilateral palmar hyperhidrosis

One of the most important therapeutic goal in hyperhidrosis treatment is to seek for the underlying cause and to tailor the treatment accordingly. A detailed history and prompt physical examination are needed to clarify the etiological factor. In this study, we report a 34-year-old woman with a diagnosis of thoracic outlet syndrome presenting with complaints of pain, numbness, and fatigue in her left arm and ipsilateral palmar hyperhidrosis. Thus, we want to highlight a specific potential cause of secondary hyperhidrosis, which can otherwise be easily overlooked, and furthermore, which has a completely different treatment strategy.

The effect of isokinetic and aerobic exercises on serum interleukin-6 and tumor necrosis factor alpha levels, pain, and functional activity in patients with knee osteoarthritis.

Objectives. The aim of this study is to investigate the effects of isokinetic and aerobic exercise training programs on serum pro-inflammatory cytokine levels, pain, and functional activity in patients with knee osteoarthritis (OA). Methods. Forty-two postmenopausal women and men with knee OA according to American College of Rheumatology diagnostic criteria were included. Patients were randomized into isokinetic and aerobic exercises and control groups. In intervention groups, patients were included in predetermined exercise programs 3 times per week for 6 weeks. Severity of pain, functional activity status, muscle strength, functional capacity, and serum cytokine levels were evaluated at baseline and at the 6th week. Results. At the end of 6th week, there was no statistically significant decrease in serum pro-inflammatory cytokine levels in both the exercise groups, although C-reactive protein levels exhibited a strong trend toward significance. We found a significant decrease in visual analog scale and Western Ontario McMaster Osteoarthritis Index scores, and significant increase in functional capacity and muscle strength in both the exercise groups compared with those in the control group.

Upper Extremity Function in Elderly Patients with Breast Cancer-Related Lymphedema: A Descriptive Study

MEME KANSERİ İLE İLİŞKİLİ LENFÖDEMİ OLAN YAŞLI HASTALARDA ÜST EKSTREMİTE FONKSİYONU: TANIMLAYICI BİR ÇALIŞMA Introduction: Lymphedema is a common complication following breast cancer treatment with physical and pyschosocial consequences. The detrimental effects of lymphedema may become more disabiling in conjuction with the aging process. The aim of the study was to evaluate upper extremity function in elderly with breast cancer-related lymphedema and investigate the associations between upper limb function and demographic/clinical characteristics. Materials and Method: Eight-four women with a mean age of 65.1±5.0 years were enrolled in this study. Demograpic characteristics including age, body mass index, dominant hand, marital status, education level, and occupation were recorded. Cancer and lymphedemarelated clinical features were reviewed. The disabilities of arm, shoulder, and hand (DASH) questionnaire was used to assess upper extremity function. Results: The mean of patients’ body mass index was 31.9±6.1 kg/cm2. The median duration of lymphedema was 8 months. Approximately 60% of patients had stage 2 lymphedema. The median value of interlimb volume difference was 558.5 ml. DASH score correlated only with body mass index, volume difference, and lymphedema stage. On regression analysis, the best predictors of upper extremity function in patients with lymphedema were found to be as body mass index and volume difference. Conclusion: The presence of breast cancer-related lymphedema negatively affects upper extremity function in elderly patients. The findings indicate that patients with higher body mass index and interlimb volume difference have more severe disability. Therefore, multimodal therapeutic interventions for reducing volume of the affected arm as well as body mass index could improve upper extremity function in older patients with lymphedema.

OP-102 ASSESSMENT OF ATRIAL CONDUCTION IN PATIENTS WITH ANKYLOSING SPONDYLITIS VIA P WAVE DISPERSION AND ATRIAL ELECTROMECHANICAL DELAY

Methods: We evaluated eighty-nine NIDCMP patients who had left ventricular ejection fraction (EF) below 45% with angiographically normal coronary arteries. Patients with organic mitral regurgitation were excluded. All patients underwent detailed echocardiographic study including mitral valve deformation indices (tenting area-TA, tenting distance-TD), global left ventricular remodelling parameters (ejection fraction-EF, sphericity index-SI, left ventricular end systolic and end diastolic volumesLVESV and LVEDV) as well as local remodelling parameters (interpapillary muscle distance-IPMD, coaptation to septal distance-CSD, mitral annular areaMAA). Severity of mitral regurgitation was quantified by PISA method and patients were divided into two groups according to their effective regurgitant orrifice areas (EROA) as; group A (severe FMR, EROA >0.2 cm2, n=41) and group B (non-severe FMR, EROA <0.2 cm2, n=48). Results: Group A patients with severe FMR had statistically lower levels of EF and higher values of sphericity, MAA, CSD, IPMD, LVESV, LVEDV, TD and TA (all p values were below 0.05) than group B. Multivariate logistic regression analysis with backward conditional method (entry criteria was accepted 0.10, removed criteria was accepted 0.20) was used to define the echocardiographic predictors of severe FMR which revealed that MAA (p=0.065, OR: 1.313), TA (p=0.02, OR: 1.997) and IPMD (p=0.045, OR: 3.802) had statistical significance. Because it had the highest correlation, TA was used in ROC analysis that established a cut-off value of 3.4 cm2 with the highest sensitivity and specificity for severe FMR (sensitivity 85% specificity 74%, AUC:0.843, p<0.001). Conclusions: Our study revealed that, local remodelling and geometrical deformation in mitral valve contribute to the development of FMR instead of global remodelling parameters in patients with NIDCMP. Among all of the echocardiographic parameters related to FMR, tenting area was found to have the highest contribution to FMR severity. Unlike the complex, time-consuming and volume dependent methods for assessing mitral regurgitation, tenting area is a simple, easy and accurate echocardiographic measure for estimating FMR severity with a low intra and interobserver variability.