Sami Hizmetli

Polypharmacy in the elderly: a multicenter study.

OBJECTIVE The aim of this study was to evaluate the polypharmacy issue and its correlations with socioeconomic variables in Turkish elderly patients. DESIGN Cross-sectional SETTING Outpatient clinics of the medical schools, departments of physical medicine and rehabilitation from 12 provinces. PARTICIPANTS A total of 1430 elderly in different geographical regions of Turkey during January 2007 to January 2008 were included. MEASUREMENTS Patients were interviewed using a questionnaire that included demographic characteristics, current medical diagnosis, and pharmaceuticals that are used by elderly. Demographical parameters were gender, age, marital status, number of children, level of education, province, and status of retirement. RESULTS The mean number of drugs was found to be higher in the females. There was a significant difference among age groups, marital status groups, and the number of children categories. The distribution of the number of drugs among education levels did not differ significantly, whereas the distribution of the number of drugs between the status of retirement and presence of chronic disease differed significantly. CONCLUSIONS Polypharmacy is correlated with various factors including age, sex, marital status, number of children, status of retirement, and presence of chronic medical conditions but not educational status in our study group.

Sympathetic skin responses in reflex sympathetic dystrophy

This study was performed to determine the utility of sympathetic skin response (SSR) in evaluating the sympathetic function and to follow up the effects of sympathetic blockade in reflex sympathetic dystrophy (RSD). Thirty patients having RSD with upper extremity involvement were randomly divided into two groups. Besides medical therapy and exercise, physical therapy agents were applied to both the groups. In addition to this treatment protocol, stellar ganglion blockade was done by diadynamic current in Group II. The normal sides of the patients were used for the control group. SSRs were measured in all the patients before and after the therapy. The amplitude was found to be increased and the latency was found to be decreased in the affected side in both the groups before the therapy. After the therapy, the amplitude was decreased and latency was increased in both the groups. But, the differences in amplitude (P=0.001) and latency (P=0.002) before and after the therapy were significantly higher in Group II. (Before the treatment, SSRs were significantly different between the normal and the affected sides in both the groups. The observed change in SSRs after the treatment was higher in Group II.) It was concluded that, SSR can be a useful and noninvasive method in diagnosing the sympathetic dysfunction in RSD and can be used for evaluating the response to sympathetic blockade and other treatment modalities.

Relapsing significant bacteriuria : Effect on urinary tract infection in patients with spinal cord injury

OBJECTIVE To evaluate whether there is a relation between relapsing significant asymptomatic bacteriuria (ASB) and symptomatic urinary tract infection (UTI), and to determine the frequency rate of UTI in patients with spinal cord injury (SCI) using indwelling catheters (IC). DESIGN Cohort study. Patients were followed up for 24 to 270 days (mean, 66.3 +/- 42.2). SETTING A department of physical therapy and rehabilitation in a research hospital of a university referral center. PATIENTS Fifty patients with SCI using IC. Patients with severe concurrent illness, known vesicouretheral reflux, urinary calculi, and severely disturbed renal function were excluded. MAIN OUTCOME MEASURE Symptomatic UTI, relapsing ASB, and recurrent significant ASB. RESULTS There was significant difference between relapsing ASB and recurrent ASB with regard to occurring symptomatic UTI (chi 2, 4.92; p < .03). Symptomatic UTI was observed at a rate of 9.35, relapsing ASB 35.59, and recurrent ASB 55.80 per 1,000 patient-days. CONCLUSION Relapsing ASB is an important factor in the development of symptomatic UTI.

2017 update of the Turkish League Against Rheumatism (TLAR) evidence-based recommendations for the management of knee osteoarthritis

In a Turkish League Against Rheumatism (TLAR) project, evidence-based recommendations for the management of knee osteoarthritis (OA) was developed for the first time in our country in 2012 (TLAR-2012). In accordance with developing medical knowledge and scientific evidence, recommendations were updated. The committee was composed of 22 physical medicine and rehabilitation specialists (4 have rheumatology subspeciality also) and an orthopaedic surgeon. Systematic literature search were applied on Pubmed, Embase, Cochrane and Turkish Medical Index for the dates between January the 1st 2012 and January the 29th of 2015. The articles were assessed for quality and classified according to hierarchy for the level of evidence, and the selected ones sent to committee members electronically. They were asked to develop new recommendations. In the meeting in 2015, the format of the recommendations was decided to be patient-based and considering the grade and the severity of the disease. By the discussion of the each item under the light of new evidences, the final recommendations were developed. Each item was voted electronically on a 10-cm visual analogue scale (VAS) and the strength of recommendation (SoR) was calculated. In the light of evidences, totally 11 titles of recommendations were developed; the first 7 were applicable to each patient in every stages of the disease, remaining were for defined specific clinical situations. The mean SoR value of the recommendations was between 7.44 and 9.93. TLAR-2012 recommendations were updated in a new format. We think that, present recommendations will be beneficial for the physicians who manage, as well as the patients who suffer from the disease.

Serum cortisol and dehydroepiandrosterone-sulfate levels after balneotherapy and physical therapy in patients with fibromyalgia.

Objectives: To investigated serum cortisol and serum dehydroepiandrosterone-sulphate (DHEA-S) levels between fibromyalgia (FMS) patients and a control group, and the effect of balneotherapy (BT) on these hormones. Methods: Seventy-two patients with FMS and 39 healthy volunteers were included in the study. This prospective and cross-sectional study was carried out in the Medical Faculty, Physical Medicine and Rehabilitation Clinic, Cumhuriyet University, Cumhuriyet, Turkey between June 2012 and June 2013. Patients were divided into 2 groups. There were 40 patients in the first group, consisting of BT and physical therapy (PT) administered patients. There were 32 FMS patients in the second group who were only administered PT. Thirty-nine healthy volunteers were enrolled as a control group. Result: Cortisol was observed to be lower in FMS patients compared with the controls (10.10±4.08 μg/dL and 11.78±3.6 μg/dL; p=0.033). Serum DHEA-S level was observed to be lower in FMS patients compared with the controls (89.93±53.96 μg/dL and 143.15±107.92 μg/dL; p=0.015). Average serum cortisol levels of patients receiving BT were determined to be 9.95±3.20 μg/dL before treatment and 9.06±3.77μg/dL after treatment; while average serum DHEA-S levels were 77.60±48.05 μg/dL before treatment, and 76.84±48.71 μg/dL after treatment. No significant changes were determined in serum cortisol and DHEA-S levels when measured again after BT and PT. Conclusion: Low levels of serum cortisol and DHEA-S were suggested to be associated with the physiopathology of FMS.

Prevalence of Rheumatoid Arthritis and Spondyloarthritis in Turkey: A Nationwide Study

Objectives This study aims to estimate the prevalence of rheumatoid arthritis (RA) and spondyloarthritis (SpA) in Turkey using the same telephone questionnaire developed for screening RA and SpA in France and used in Serbia and Lithuania. Material and methods The study was performed in two steps. In step I, the French questionnaire was translated into Turkish and validated through a group of 200 patients (80 males, 120 females; mean age 44.0±13.1 years; range 19 to 75 years) followed up at the rheumatology departments of University Hospitals in Antalya and Ankara. In step II, the validated Turkish questionnaire was administered face-to-face to randomly selected 4,012 subjects (1,670 males, 2,342 females; mean age 41.5±16.8 years; range 16 to 97 years) by trained general practitioners across the country, in 25 prov- inces for case detection. The subjects who were suspected of having RA or SpA in accordance with the questionnaire were invited to the nearest university hospital for rheumatologic examination in order to confirm the diagnosis. Results In step II, a total of 25 subjects (2 males, 23 females) were diagnosed as RA. The standardized RA prevalence for the general population of Turkey was calculated as 0.56% (95% confidence interval [CI]; 0.33-0.79), 0.10% (95% CI; -0.05-0.25) for males and 0.89% (95% CI; 0.51-1.27) for females. A total of 18 subjects (3 males, 15 females) were diagnosed as SpA. The standardized SpA prevalence for the general population of Turkey was 0.46% (95% CI; 0.25-0.67), 0.17% (95% CI; -0.03-0.37) for males and 0.65% (95% CI; 0.32-0.98) for females. The prevalence of RA was highest in the Northern region (2.00%) and the prevalence of SpA was highest in the Central region (1.49%). Conclusion The prevalences of RA and SpA in Turkey are close to each other and there are significant inter-regional variations in prevalences of both RA and SpA.

AB0786 Circadian Rhythm of Melatonin in Ankylosing Spondylitis: Correlation with Disease Activity, Quality of Life and Enthesitis Score

Background Due to its effect on the immune system and antioxidant features melatonin (MLT) has attracted a great deal of attention in recent years. Its role in pathogenesis of chronic inflammatory diseases have been studied. However only few studies have investigated its role in Ankylosing Spondylitis (AS). Objectives The aim of this study is to investigate the circadian rhythm of MLT and its relationship with disease activity, quality of life and enthesitis score in AS patients. Methods Sixteen AS patients diagnosed according to the Modified New York 1984 criteria and 16 age and sex matched healthy controls were enrolled in the study. Serum MLT levels were measured at 20:00, 03:00 and 08:00 via melatonin direct radioimmunoassay kit (LDN BA R-3300) in both groups. Bath AS Disease Activity Score (BASDAI), Bath AS Functional Index (BASFI), Maastricht AS Enthesitis Score (MASES) and AS Quality of Life (ASQoL) were calculated in AS group. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were measured, duration of morning stiffness was questioned Results The mean morning (08:00) and evening (20:00) MLT levels were significantly higher in the patient group (34.00±13.51 pg/ml versus 24.88±7.10 pg/ml and 34.25±7.92 pg/ml versus 27.75±8.25 pg/ml respectively) (p<0.05). The mean MLT level at night (03:00) was also higher in AS group but the difference did not reach statistical significance. (98.81±39.16 pg/ml versus 73.94±30.49 pg/ml) (p:0.054). A significant positive correlation was found between morning and night MLT levels and duration of morning stiffness, BASDAI, BASFI, ASQoL and MASES scores. No significant correlation was found between evening MLT levels and these parametres. Also no correlation was found between acute phase reactants (ESR,CRP) and the MLT levels.(Table) Conclusions Ankylosing Spondylitis patients have higher melatonin levels and the melatonin levels of AS patients are associated with the duration of morning stiffness, disease activity, quality of life and enthesitis scores. We suggest that our results should be supported by studies performed in wider study populations also involving patients with non-radiographic axial spondyloarthritis as a subgroup and with more frequent melatonin measurements performed especially at night in order to assess the exact circadian rhythm of melatonin in spondyloarthritis. References Cutolo M, Maestroni GJ,Otsa K, Aakre O, Villaggio B, Capellino S et al. Circadian melatonin and cortisol levels in rheumatoid arthritis patients in winter time: a north and south Europe comparison. Ann Rheum Dis 2005;64:212-216 Senel K,Baykal T, Melikoglu MA, Erdal A, Karatay S, Karakoc A, Ugur M. Serum melatonin levels in ankylosing spondylitis: correlation with disease activity. Rheumatol Int 2011;31:61-63 Senna MK, Olama SM, El-Arman M. Serum melatonin level in ankylosing spondylitis: is it increased in active disease. Rheumatol Int 2012;32:3429-3433. Disclosure of Interest None declared

Fibromiyalji Hastalarında Serum Kortizol Düzeyinin Depresyon ile İlişkisi

Purpose: The fundamental objective of this study is to determine the depression levels and to review its relations with serum cortisol levels in cases presenting with fibromyalgia (FM). Materials and Methods: Seventy one patients participated in this study who referred to physiotherapy department, and approved to participate in this study, and they were diagnosed with FM by physiotherapists according Association and they were referred to American