Ozlem Senocak

The relation between tooth loss and bone mass in postmenopausal osteoporotic women in Turkey: a multicenter study

Abstract. The purpose of this study was to investigate the associations of tooth loss with skeletal bone mass, years since menopause, educational level, current smoking status, dietary calcium intake, and number of pregnancies in postmenopausal osteoporotic women in Turkey. The study population consisted of 1171 postmenopausal women aged 40–86 years (mean age, 61.19 ± 7.28 years). A detailed history was obtained from all women, including relevant lifestyle parameters, risk factors, and measurements of weight and height. Women were separated into three groups according to the number of teeth remaining as group 1 (edentulous, 457 women), group 2 (10 or fewer teeth, 232 women), and group 3 (more than 10 teeth remaining, 482 women). There was no significant difference among the three groups in mean age and menopausal age (P < 0.05). Body mass index of group 1 was significantly higher than that of group 2 (P < 0.01). Educational level was significantly different between three groups: groups 1 and 2 (P < 0.001), groups 1 and 3 (P < 0.0001), and groups 2 and 3 (P < 0.001). Educational level was lowest in group 1 and highest in group 3. Despite a low ratio of cigarette smoking in general, a smoking habit was most prevalent in group 3 and least in group 2. The ratio of women receiving adequate calcium was significantly lower in group 1 than in other groups (P < 0.001); mean calcium intake was similar in all groups. The number of pregnancies was significantly higher in group 1 than in other groups (P < 0.001). Lumbar bone mineral density (BMD) of group 1 was significantly lower than that of groups 2 and 3 (P < 0.001). Although no significant difference was found between groups 1 and 3, femoral neck BMD of group 2 was less than in others, and differences between groups 1 and 2 and between groups 2 and 3 (P < 0.001) were significant. Lumbar bone mineral content (BMC) of group 1 was significantly lower than that of groups 2 and 3 (P < 0.001), and lumbar BMC in group 2 was significantly higher than in group 3 (P < 0.05). Femoral neck BMC in group 1 was significantly higher than in groups 2 and 3 (P < 0.001). In conclusion, lumbar BMD and BMC in the edentulous group were significantly lower, whereas femoral neck BMD and BMC were significantly higher in edentulous group compared with the others. Our findings indicated that improvement in lifestyle factors and nutritional strategies for the treatment and prevention of osteoporosis may have additional benefit in reducing tooth loss.

Ef” cacy of two forms of electrical stimulation in increasing quadriceps strength: a randomized controlled trial

Objective: To investigate whether electrical stimulation is effective in improving quadriceps strength in healthy subjects and to compare interferential and low-frequency current in terms of the effects on quadriceps strength and perceived discomfort. Design: Randomized, controlled study. Setting: Physical Medicine and Rehabilitation Department in a university hospital. Subjects: Thirty medical faculty students, divided into three groups, participated in the study. Interventions: Group A received electrical stimulation with bipolar interferential current while group B received electrical stimulation with lowfrequency current (symmetrical biphasic). Group C served as the control group. Electrical stimulation was given for 15 minutes, ”ve days a week for three weeks, at a maximally tolerated intensity with the knee fully extended in the sitting position. Main outcome measures: Before and after the study, quadriceps strength was measured with a Cybex dynamometer isokinetically at the angular velocities of 60°/s and 120°/s. The perceived discomfort experienced with each type of electrical stimulation was quantified by the use of a visual analogue scale (VAS). Results: Statistically significant increase in isokinetic strength was observed after training in group A and group B. Increase in strength did not differ between the stimulation groups. No significant change in strength occurred in group C. Perceived discomfort by the stimulation groups was not significantly different. Conclusion: Both interferential and low-frequency currents can be used in strength training with the parameters used in this study.

Technetium-99m human immunoglobulin scintigraphy in patients with adhesive capsulitis : A correlative study with bone scintigraphy

Adhesive capsulitis (AC) is a disorder that is characterized by shoulder pain and progressive limitation of both active and passive shoulder motion. Although the underlying pathological mechanisms of the disease are not well understood, the inflammatory reactions depending on the stage have been demonstrated histologically. The purpose of the study is to investigate the inflammatory changes that can be demonstrated with Tc-99m HIG in AC, and to determine the presence of correlations between scintigraphic findings and the clinical assessment. Twenty-one patients (12 females and 9 males) with a mean age of 50.57±8.49 were included in the study. AC was diagnosed according to recognized criteria. The planar X-ray images of the affected shoulders of all patients were normal. The patients were evaluated with the Constant Scoring System, and the functional and pain assessment parts of the American Shoulder and Elbow Surgeons’ Form (ASES). Three phase bone scans and Tc-99m HIG scintigraphy were performed at least two days apart. Bone scan and Tc-99m HIG scintigraphy were evaluated visually and HIG uptake was evaluated in comparison with the contralateral normal shoulder. Bone scan demonstrated hypervascularity in 9 of the 21 patients (43%), whereas increased osteoblastic activity was detected in 19 (90%) in the affected shoulder. Tc-99m HIG uptake was positive in 12 (57%), and negative in 9 (43%) patiens. All patients with increased Tc-99m HIG accumulation in the affected shoulder, also had increased osteoblastic activity on Tc-99m bone scintigraphy. A significant correlation was found between HIG uptake and constant, functional and pain scores. The difference between these scores was also statistically significant in patients with HIG positive and negative uptake. This study indicates that there is a good correlation between Tc-99m HIG scan findings and clinical scores. Tc-99m HIG accumulation in the affected shoulder may be related to continuing inflammatory reaction to AC. Tc-99m HIG scan may be a noninvasive, complementary method for demonstrating continuing inflammatory changes and may help in staging the disease.

Motor conduction time along the cauda equina in patients with lumbar spinal stenosis.

Study Design. Magnetic lumbar stimulation was used to detect spinal nerve degeneration in patients with lumbar spinal stenosis (LSS). Objective. To evaluate delays in the motor conduction time in the cauda equina of patients with LSS. Summary of Background Data. Previous studies suggested a bilateral slowing of motor conduction in the cauda equina in LSS. Among several methods, only magnetic stimulation is sufficiently sensitive for detecting potential degeneration in LSS. A recent study demonstrated the direct calculation of the cauda equina motor conduction time using magnetic stimulation at proximal and distal sites of the cauda equina. We used this technique to determine potential degeneration in patients with LSS. Methods. Twenty adult subjects and 15 patients with LSS were investigated. Lumbosacral roots were stimulated at intervertebral levels L1–L2 and L5–S1 by magnetic coil stimulation. The muscle responses to stimulation were recorded from the gastrocnemius-soleus, and anterior tibialis muscles on both sides with bipolar surface electrodes. The response latency from stimulations at the L5 spine level were subtracted from those at the L1 level on the same side. This value represented the conduction time from the proximal to distal ends of the cauda equina. Results. The mean conduction time along the cauda equina was significantly prolonged in patients with LSS compared with controls. The mean cauda equina motor conduction time was 1.97 ± 0.67 milliseconds in controls and 3.57 ± 2.22 milliseconds in patients with LSS (P = 0.00). Conclusion. Determining the motor conduction time along the cauda equina using L1 and L5 magnetic stimulation provides an effective alternative method for evaluating the lumbar motor roots in patients with LSS.

Efficacy and safety of urinary catheters with silver alloy coating in patients with spinal cord injury: a multicentric pragmatic randomized controlled trial. The ESCALE trial

BACKGROUND Patients with spinal cord injury (SCI) who carry indwelling urinary catheters have an increased risk of urinary tract infection (UTI). Antiseptic silver alloy-coated (SAC) silicone urinary catheters prove to be a promising intervention to reduce UTIs; however, current evidence cannot be extrapolated to patients with SCI. PURPOSE This study aimed to assess the efficacy of SAC urinary catheters for preventing catheter-associated urinary tract infections. DESIGN/SETTING This is an open-label, multicenter (developed in Spain, Portugal, Chile, Turkey, and Italy), randomized clinical trial conducted in 14 hospitals from November 2012 to December 2015. PATIENT SAMPLE Eligible patients were men or women with traumatic or medical SCI, aged ≥18 years, requiring an indwelling urinary catheter for at least 7 days. OUTCOME MEASURES The primary outcome was the incidence of symptomatic UTIs. The secondary outcome included bacteremia in the urinary tract and adverse events. MATERIALS AND METHODS Patients were randomized to receive a SAC urinary catheter (experimental group) or a standard catheter (control group) for at least 7 days. Data were compared using chi-squared test and also calculating the absolute risk difference with a 95% confidence interval. An adjusted analysis including different risk factors of UTI was performed. This study was mainly funded by La Marató de TV3 Foundation (grant number # 112210) and the European Clinical Research Infrastructures Network organization. The funders had no role in the interpretation or reporting of results. RESULTS A total of 489 patients were included in the study, aged 55 years in the experimental group and aged 57 in the control group (p=.870); 72% were men; 43% were hospitalized patients, and 57% were outpatients (p=1.0). The most frequent cause of SCI was traumatic (73.75%), and the localization was mainly the cervical spine (42.74%). Most of the patients had an A score (complete spinal injury and no motor and sensory is preserved) on the ASIA scale (62.37%). The median time of urethral catheterization was 27 days in the experimental group and 28 days in the control group (p=.202). Eighteen patients (7.41%) in the experimental group and 19 in the control (7.72%) group had a symptomatic UTI (odds ratio [OR] 0.96 [0.49-1.87]). The adjusted analysis revealed no change in the results. Only three patients in the experimental group had bacteremia within the urinary tract. The experimental group presented more adverse events related to the use of a catheter than the control group (OR 0.03 [0.00-0.06]). CONCLUSIONS The results of this study do not support the routine use of indwelling antiseptic SAC silicone urinary catheters in patients with SCI. However, UTIs associated to long-term urinary catheter use remain a challenge and further investigations are still needed.

Clinical history for inflammatory back pain in ankylosing spondylitis: the sensitivity, specificity and consistency of clinical features.

Among patients with chronic back pain the prevalence of spondyloarthritides (SpA) was found to be 5% [1]. InXammatory back pain (IBP) is the key symptom of SpA and is present in around 75% of patients with ankylosing spondylitis (AS). Clinical detection of IBP is often diYcult. In the screening questionnaire by Calin et al. [2] clinical characteristics of back pain that is in a patient younger than 40 years, insidious in onset, persisting for at least 3 months, associated with morning stiVness and improving with exercise were found to be 95% sensitive and 76% speciWc for AS in comparison with mechanical low back pain (MLBP). Although clinical deWnition of back pain in modiWed New York criteria for AS [3] was based on the Wndings of Calin et al., subsequent studies showed that the sensitivity and speciWcity of the original proposal were about only 23 and 75% [4, 5], respectively. In the present cross-sectional study, we re-explore the sensitivity, speciWcity and consistency of criteria set for IBP proposed originally by Calin et al. [2]. Sixty-one consecutive patients with AS (16 female, 45 male; mean age 38.4 [18–65] years and mean disease duration: 14.2 [0–35] years) according to modiWed New York criteria [3] and 31 patients with MLBP (24 females, 7 males; mean age 43.9 [20–72] years and mean disease duration: 9.2 [0–43] years) were included in the study. Patients with AS were recruited from two university hospital rheumatology outpatient clinics. Patients with mechanical back pain were either the attendees of back school or outpatient clinic of physical therapy and rehabilitation unit of a university hospital. Two independent rheumatologists using a structured questionnaire based on the Calin’s original proposal [2] performed a face-to-face interview with each subject (Table 1). Unfortunately, this is not a blinded study since the most of the AS patients has established disease with an obvious deformity and the observers were the staVs on the sites which the patients were included and interviewed. Both patients and control groups were recruited from hospital outpatient clinics and all patients had back pain therefore speciWcity values for question 1 and 10 could not be calculated. The Wve features of back pain (age at onset <40 years, insidious onset, duration of pain ̧3 months, presence of morning stiVness and improvement with exercise) were found to be highly sensitive and speciWc for the diagnosis of AS as shown by the original study (Table 1). In our study, the presence of at least 4 of 5 criteria deWned by Calin et al. had a sensitivity of 93.4% (95% CI 84–98.1 and positive likelihood ratio [LR] of 9.7) in the Wrst questionnaire and 96.6% (95% CI 88.4–99.5 and positive LR of 9.9) in the second questionnaire. Respective speciWcity values were 90.3% (95% CI 74.2–97.8) in both. One of the interviewers also questioned the duration of morning stiVness in the patients reporting morning stiVness. When morning stiVness was deWned as a duration of ̧30 min, a sensitivity of 76.7% and a speciWcity of 87.1% was obtained. The question of “awakening due to back pain at S. Akar (&) · M. Birlik · N. Akkoc · F. Onen Division of Rheumatology, Dokuz Eylul University School of Medicine, Dokuz Eylul Universitesi TÂp Fakultesi, Ic Hastaliklari AD, Immunoloji-Romatoloji BD, Inciralti, 35340 Izmir, Turkey e-mail: servet.akar@deu.edu.tr

Neuralgic amyotrophy as the primary cause of shoulder pain in a patient with rotator cuff tear

A 66-year-old woman with no history of trauma presented with severe shoulder pain. Magnetic resonance imaging revealed rupture of the supraspinatus tendon, for which surgical treatment was considered. However, it was noted that shoulder pain was accompanied by weakness in the shoulder muscles, and the patient underwent electroneuromyographic examination, which revealed neuralgic amyotrophy. Following physical therapy and rehabilitation combined with appropriate medical therapy, her symptoms significantly improved. In cases with severe shoulder pain without a trauma history, characteristics of pain should be thoroughly analyzed and neuralgic amyotrophy considered in the differential diagnosis.

P064 Motor conduction time along with superior and inferior gluteal nerves an electrophysiological study in healthy subjects and in patients with hip operations

hibitory and facilitatory mechanisms in both hemispheres of newly diagnosed PTSD patients. Methods: Fifteen medication-free PTSD patients and ageand gendermatched healthy controls underwent the assessment of corticospinal excitability by recording single and double pulse TMS variables from the right and left FDI muscles. Resting motor threshold (testing ion channel function), the CSP (reflecting a putative GABAb-mediated mechanism), SICI and SICF (reflecting putative GABAa and glutamate mechanisms, respectively) and SAI (reflecting a putative cholinergic mechanism) were collected after stimulation of the primary motor cortex of both hemispheres. All subjects were clinically assessed by SCID I, SCID II, HAM-A and HAM-D. Furthermore, PTSD patients were characterized for disorder-specific symptoms by means of the Clinician Administered Post-Traumatic Stress Disorder Scale (CAPS). The study design was approved by the University of Siena Committee and was prepared in accordance with the Ethical standards of declaration of Helsinki. Results: SICI was bilaterally reduced or reversed, and SICF was enhanced in PTSD patients. Preliminary analysis is showing that the glutammatergic tone is prevalent in the right hemisphere; moreover, a positive correlation between increased SICF and certain psychopathological domains is emerging. Conclusions: This study confirms neurophysiological evidence of a bilaterally reduced GABAergic tone in PTSD patients, and suggests that even hyperglutammatergic mechanisms might play a role in the pathophysiology of some PTSD symptoms.