Semra Akturk

Association between Red Cell Distribution Width and Disease Activity in Patients with Behcet’s Disease

Aims: we aimed to investigate whether red cell distribution width (RDW) can also be used for the assessment of disease activity in Behcet’s disease (BD). Methods and results: Forty patients with active BD and seventy patients with inactive BD were included in the study. Forty-six healthy volunteers constituted the control group. Hematological parameters, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were analyzed by standard methods. All the individuals underwent comprehensive echocardiographic examination. Echocardiographic parameters of the study population were similar all groups. ESR, CRP and RDW were significantly higher in active BD patients than in inactive BD patients and controls (33.6±22 vs 15.7±9 vs 5±4.1, 23.4±21.6 vs 5.5±6.2 vs 1.2±0.5 and 17.2±2.5 vs 14.4±1.9 vs 13.2±0.5, p<0.0001 for all, respectively). Moreover, we also found that ESR, CRP and RDW were significantly higher in inactive BD patients when compared with the controls (15.7±9 vs 5±4.1, 5.5±6.2 vs 1.2±0.5 and 14.4±1.9 vs 13.2±0.5, p<0.0001 for all, respectively). There were modest positive correlations between RDW and disease duration (r=0.320, P=0.001). Conclusion: We demostrated that RDW significant increased in active and inactive BD patients without cardiac involvement. In addition, our study has established that RDW can be used to determine the disease activity state of BD.

Association between serum total antioxidant status and flow-mediated dilation in patients with systemic lupus erythematosus: an observational study.

Objective: Endothelial dysfunction (ED) is a condition that involves increased oxidative stress and decreased total antioxidant status (TAS) levels. Systemic lupus erythematosus (SLE) is also associated with ED. We aimed to determine the association between serum TAS and ED as assessed by flow-mediated dilation (FMD) in patients with SLE. Methods: Thirty-four patients with stable SLE who were not undergoing any treatment and 39 healthy volunteers without any overt cardiovascular disease were included in this cross-sectional study. Doppler ultrasound was used to measure FMD to assess ED in the study groups. Serum TAS levels were measured using a TAS kit. High-sensitivity C-reactive protein (hs-CRP) and anticardiolipin antibody (aCLA) levels were also measured to assess the inflammatory state. The SLE group further was divided into 2 groups according to presence or absence of aCLA. SLE disease activity was assessed using the SLE disease activity index (SLEDAI). Regression analysis was used to define independent predictors. Results: The mean TAS levels were significantly lower in patients with SLE than in controls (1.60±0.11 versus 1.73±0.15 mmol/L, p<0.001). hs-CRP levels were significantly higher in patients with SLE than in controls (8.2±6.0 vs. 2.9±4.0 mg/L; p<0.001), particularly in SLE patients with positive aCLA when compared with SLE patients with negative aCLA (13.8±4.3 vs. 5.6±4.8 mg/L, p<0.001). The FMD percent was significantly lower in patients with SLE than in controls (8.1±4.9 vs. 10.6±4.7, p=0.04). There was a significant positive correlation between FMD and TAS in the SLE group (r=0.448, p=0.008) and the control group (r=0.367, p=0.03) and a significant negative correlation between FMD and serum hs-CRP (r=-0.368, p=0.04) in only the SLE group. In multiple linear regression analysis, TAS, hs-CRP and SLEDAI were independently correlated with FMD (ß=0.50, p=0.003; ß=-0.33, p=0.03; and ß=-0.36, p=0.03; respectively). Conclusion: Patients with SLE who have no overt cardiovascular disease are at increased risk for ED and this may be associated with underlying inflammation and impairment of TAS.

Metastatic gastric adenocarcinoma in a pregnant woman

Gastric cancers occur in only 0.025% to 0.1% of all pregnancies. We present a pregnant woman with gastric adenocarcinoma associated with bone metastasis. She is 36-year-old (gravida:4, para:0) 16-week pregnancy, complaining of nausea, vomiting, weight loss (~15 kg) and low back pain. Although the patient considered the condition to be related with pregnancy and underestimated its importance. She had high erythrocyte sedimentation rate (107 mm/h) and anemia (hemoglobin = 9.4 gr/dl). Lumbar magnetic resonance imaging showed L4 vertebrae malign compression fracture and diffuse bone metastasis. Because of the patients melena, esophagogastroduodenoscopy was performed and biopsy result was reported as stomach adenocarcinoma. It is important to evaluate the symptoms of low back pain and pregnancy related symptoms carefully and do not cause delays in diagnosis due to overlapping symptoms.

Comparison of high-intensity laser therapy and combination of transcutaneous nerve stimulation and ultrasound treatment in patients with chronic lumbar radiculopathy: A randomized single-blind study

Objective: To compare the effects of high-intensity laser therapy (HILT) and a combination of transcutaneous nerve stimulation (TENS) with ultrasound (US) therapy on pain and functionality in patients with chronic lumbar radiculopathy. Methods: This prospective randomized comparative study was conducted in Department of physical medicine and rehabilitation, Turgut Ozal Medicine Center, Malatya, Turkey from April 2016 to September 2016. A total of 54 patients with chronic lumbar radiculopathy were enrolled in this study. The patients were randomly divided into two groups: Group 1 (n:27) received 10 sessions of a combination of hot pack, TENS, US and exercise, and Group 2 (n:27) received hot pack, HILT and exercise. The outcomes measured were low back with unilateral leg pain level measured by visual analog scale (VAS) and functionality measured with the Oswestry Disability Index (ODI) at the end of the therapy and four weeks later. p-value less than 0.05 considered statistically significant. Results: In two groups, VAS (low back with unilateral leg pain) and ODI scores showed significant changes. At the end of the 2 weeks intervention, participants in Group-1 showed a significantly greater decrease in pain than participants in Group-2. Statistically significant differences in pain variation and functionality (VAS and ODI) were observed four weeks after treatment sessions for participants in the TENS+US therapy group compared with participants in the HILT group. Conclusion: HILT and TENS+US combined with exercise were effective treatment modalities in decreasing the VAS and ODI scores. TENS+US combined with exercises were more effective than HILT combined with exercise.

Comparision of the effectiveness of ESWT and ultrasound treatments in myofascial pain syndrome: randomized, sham-controlled study

[Purpose] The purpose of this study is to compare effectiveness of extracorporeal shock wave therapy (ESWT), ultrasound (US) and sham ESWT in the treatment of myofascial pain syndrome (MPS). [Subjects and Methods] Sixty MPS patients aged 18–60 years were included in the study. The patients were randomized equally into 3 groups. Group 1 received ESWT for 4 session with 3 day-intervals. Group 2 received 4 sessions of sham ESWT. US was applied to Group 3 for 10 sessions. All patients were recommended an exercise program. The patients were evaluated before-post and 6 weeks after treatment. Measurements were made using pressure pain threshold (PPT), pain score (PS) and visual analogue scale (VAS). Patients were evaluated by using SF-36 and HADS (hospital anxiety and depression scale). [Results] A significant posttreatment difference was found in VAS, PPT and SF-36 subparameters in group 1. In group 2, a significant difference was not found in any parameter. In group 3, a significant difference was detected in parameters of VAS and PPT. A significant difference was found between groups 1 and 2 as for subtitles of PPT, VAS, SF-36. [Conclusion] These results suggest that ESWT is as effective as US. ESWT and US are significantly more effective than sham ESWT.

Radial nerve neuropathies: a retrospective analysis

Aim: Radial nerve neuropathy is a less common neuropathy among other upper extremity entrapment neuropathies. The aim of this study was to evaluate patients referred to our electrophysiology laboratory with a diagnosis of radial nerve neuropathy. Material and Methods: Electrophysiological finding of the 42 patients who were referred to the electrophysiology laboratory with the preliminary diagnosis of radial nerve lesion between 2017-2018 were retrospectively scanned. Results : Forty-two patients were included in the study. 36 patients were male (85.7%), 6 were female (14.3%) and the mean age was 36.09 ± 14.26. Evaluating the relationship between the etiology of the nerve injury showed that the highest rate was consisted of radial nerve sensory and motor axonal lesions which occurred after traffic accidents. The majority of the patients had dropped hand and finger (85.7%). Conclusion : In the etiology of radial nerve lesions, the causes such as trauma and work accidents are at the forefront and this may explain the increased incidence in men. Electromyography can provide valuable contributions to diagnosis, treatment planning and prognosis.

Median nerve ultrasound in carpal tunnel syndrome with normal electrodiagnostic tests

Introduction To evaluate the ultrasound findings of the median nerve in patients with clinical assigned carpal tunnel syndrome but normal nerve conduction studies. Methods This prospective, cross-sectional study involved 41 patients (51 hands) with clinically assigned CTS and normal nerve conduction studies and 20 healthy controls (30 hands). Ultrasonography was performed in all participants, and cross-sectional area (CSA), hypoechogenicity, and mobility of the median nerve were evaluated. All patients were assessed with Boston Carpal Tunnel Questionnaire (BCTQ). Results CSA of the median nerve in the wrist was significantly higher in the patient group when compared to the control group. Echogenicity and mobility were significantly decreased in the patient group. Ultrasound abnormalities were positively correlated with clinical features. A significant correlation was observed among sensory loss, provocative tests, body mass index, BCTQ, and high CSA. Conclusion US can help the clinicians with the diagnosis of carpal tunnel syndrome in patients with clinical symptoms but negative nerve conduction study results.

Does Osteoporosis with Type 2 Diabetes Mellitus (Diabetoporosis) increase the risk of fracture

Our aim was to investigate whether the association of diabetes and osteoporosis caused an increased risk of fracture or not. The study included 120 patients with osteoporosis aged between 40-90 years. Age, gender, body mass index (BMI), history of fracture and presence of Type 2 diabetes mellitus (T2DM) were recorded. 10-year major fracture and hip fracture risks were calculated with FRAX-WHO Fracture Risks Assessment Tool. Bone mineral density (BMD) measurements were made from femur neck and lumbar 1-4 vertebrae. All of the 120 patients included in the study, 21 were male and 99 were female. Twenty patients had T2DM diagnosis. The patient group with T2DM was older than the non-T2DM group in terms of mean age (p0.05). The number of patients with previous history of fracture was 24, and two of them were suffering from T2DM. In this study, Our results showed that osteoporosis with Type 2 Diabetes Mellitus may not significantly affect the fracture risk. The relationship between diabetes and bone metabolism should be screened in larger quantities, and T2DM should be positioned among the algorithms that assess the risk of fracture.

Syndrome of Remitting Seronegative Symmetrical Synovitis with Pitting Edema (RS3PE): A Case Report and Review of the Literature -

Remitting Seronegative Symmetrical Synovitiswith Pitting Edema (RS3PE) is a rare clinical entitythat is easilymissed due to lack of knowledge. Syndrome is characterized by suddenonset of edema with swellingon thedorsum of thehandsand by synovitis. Serological tests are negative and radiographic joint destruction does not occurs. Etiology of RS3PE syndrome is not known. It can occur as an idiopathic phenomenon, but also is in association with rheumatic diseases. In addition, several reports have described RS3PE as a paraneoplasticsyndrome can occuron concomitantly with both hematological and solidmalignancies. Because of this clinical association, it is not very easy to diagnose this syndrome. We discuss a case of RS3PE where the patient presented with acute onset polyarthritis and pitting edema of the extremities without an underlying systemic cause. Patient showed dramatic response with low dose steroid therapy.

An acute myocardial infarction due to Brucella prosthetic valve endocarditis starting shortly after the onset of non-specific symptoms.

Brucellosis most commonly causes fever, drenching night sweats and musculoskeletal symptoms, but in 1–2% of cases, it becomes complicated with endocarditis, which accounts for most of the mortality.1 ,2 Brucella prosthetic valve endocarditis (PVE) is a rare entity, and available data are limited to case reports or small case series. We present a case report in which a 36-year-old man was admitted to the hospital with new-onset generalised muscle and back pain. Rheumatology clinic hospitalised the patient …