Serpil Tuna

The relation of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume with the presence and severity of Behçet's syndrome.

Behçets syndrome (BS) is associated with chronic inflammation and endothelial dysfunction. Although there have been extensive investigations on neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), and mean platelet volume (MPV) in many diseases, their roles in BS is unclear. The purpose of the present study was to evaluate NLR, PLR, and MPV levels in BS patients and explore their clinical significance. The study included 254 patients with BS and 173 healthy individuals. Age, sex, age of onset, duration of disease, smoking, Behçet activity score, total white blood counts, neutrophil, platelet, and T lymphocyte counts of the patients were recorded. White blood cell (WBC), neutrophil, platelet, NLR, and PLR were significantly higher in patients with BS when compared with healthy controls (all p < 0.001). Lymphocyte counts and MPVs of the BS group were not statistically different from healthy controls (all p > 0.05). In the BS group, PLR and MPV were significantly different among the three severity groups (p = 0.037 and p = 0.016, respectively). We showed that any laboratory markers were not associated with joint, eye, central nervous system, large vessel, or gastrointestinal involvement in BS. NLR was shown to be an independent factor for BS by multivariate analysis. We suggest that NLR can be considered to be a diagnostic criterion of BS given the support of the findings from larger prospective studies.

The relationship between radiological severity and functional status in patients with knee osteoarthritis.

In this study, we aimed to explore the relationship between radiological findings and functional status in patients with knee osteoarthritis (OA). In this study, 117 female patients diagnosed with knee osteoarthritis according to the ACR criteria were included. Antero-posterior knee radiographs of the patients were graded according to Kellgren–Lawrence, and functional capacity was evaluated with WOMAC and Lequesne indexes. Quadriceps and hamstring muscle strengths were also concentrically measured using an isokinetic dynamometer, five repetitions at 90°/s and 20 repetitions at 180°/s. In this study, a significant relationship was determined between the age, weight, praying period, and pain period of the patients with the radiological findings. No significant relationship was determined between the functional capacity of knee and muscle strength and the radiological findings. However, left hamstring functioning capacity was found as lower in the group with the radiological findings. The radiological findings in knee OA are not associated with decrease in knee muscle strength and functional capacity. Clinical symptoms such as pain, decrease in range of motion, etc. in knee OA may be responsible for decrease in knee muscle strength and functional capacity.

The relationship between knee osteoarthritis and osteoporosis.

OBJECTIVE The aim of this study was to investigate the association between knee osteoarthritis (OA) and bone mineral density (BMD) in the femur and lumbar vertebrae. MATERIALS AND METHODS A total of 74 female patients (mean age 61.9 ±9.1 years, mean body mass index 27.09±4.24) diagnosed with knee OA were included in this study. To assess knee OA, bilateral weight-bearing antero-posterior knee radiographs were taken and graded from 0 to 4 according to Kellgren-Lawrence criteria. The BMD of the subjects was measured using dual-energy X-ray absorptiometry (DEXA). BMD measurements of those with OA were compared with those without OA. RESULTS While there was no correlation between BMD and the grade of knee OA, a significant negative correlation was found between age and femur BMD. Body mass index was positively correlated with OA and negatively correlated with OP. CONCLUSION Further investigations are needed to demonstrate the association between knee OA and BMD.

Limbus Vertebra Presenting with Inflammatory Low Back Pain: A Case Report

Limbus vertebra is a condition characterized by marginal interosseous herniation of the nucleus pulposus, and causes non specific symptoms like low back pain, back pain, muscle spasms and radiculopathy. It is frequently confused with vertebral fracture, infection, schmorl nodule or tumour because it has not a spesific symptom. It usually causes mechanical low back pain rather than inflammatory low back pain. We reported a patient presented with inflammatory low back pain and diagnosed with anterior limbus vertebra because it is rare and the patient has atypical clinical presentation.

Common Mistakes in the Dual-Energy X-ray Absorptiometry (DXA) in Turkey. A Retrospective Descriptive Multicenter Study

BACKGROUND Osteoporosis is a widespread metabolic bone disease representing a global public health problem currently affecting more than two hundred million people worldwide. The World Health Organization states that dual-energy X-ray absorptiometry (DXA) is the best densitometric technique for assessing bone mineral density (BMD). DXA provides an accurate diagnosis of osteoporosis, a good estimation of fracture risk, and is a useful tool for monitoring patients undergoing treatment. Common mistakes in BMD testing can be divided into four principal categories: 1) indication errors, 2) lack of quality control and calibration, 3) analysis and interpretation errors, and 4) inappropriate acquisition techniques. The aim of this retrospective multicenter descriptive study is to identify the common errors in the application of the DXA technique in Turkey. METHODS All DXA scans performed during the observation period were included in the study if the measurements of both, the lumbar spine and proximal femur were recorded. Forearm measurement, total body measurements, and measurements performed on children were excluded. Each examination was surveyed by 30 consultants from 20 different centers each informed and trained in the principles of and the standards for DXA scanning before the study. RESULTS A total of 3,212 DXA scan results from 20 different centers in 15 different Turkish cities were collected. The percentage of the discovered erroneous measurements varied from 10.5% to 65.5% in the lumbar spine and from 21.3% to 74.2% in the proximal femur. The overall error rate was found to be 31.8% (n = 1021) for the lumbar spine and 49.0% (n = 1576) for the proximal femur. CONCLUSION In Turkey, DXA measurements of BMD have been in use for over 20 years, and examination processes continue to improve. There is no educational standard for operator training, and a lack of knowledge can lead to significant errors in the acquisition, analysis, and interpretation.

Neutrophil/Lymphocyte Ratio, Platelet/Lymphocyte Ratio and Mean Platelet Volume in Behçet Disease Patients with and without Ocular Involvement

Objective: To evaluate the relationship between neutrophil/lymphocyte ratio (NLR), mean platelet volume (MPV), and platelet/lymphocyte ratio (PLR) and risk of ocular involvement in Behçet Disease (BD). Material and Methods: This prospective randomised study included 45 patients with ocular BD (Group1), and 86 patients with BD without ocular involvement (Group2) and 90 control subjects. The NLR, MPV, PLR and other laboratory tests were evaluated in the groups. Results: A significant difference was found in NLR and PLR values between patients with BD (n=131) and control subjects (n=90) (p<0.001). No statistically significant difference in laboratory parameters was found in BD group without ocular involvement when compared with ocular BD group, except MPV level. There was a positive correlation between MPV and activation of ocular BD (p<0.001). In the receiver-operating characteristic analysis, MPV cut off point was 8.80 and predicted the presence of active ocular BD with 66.7% sensitivity and 60.4% specificity. HLA-B51 positivity is higher in patients with ocular BD than BD without ocular involvement (p<0.001). Conclusion: Our results show that increased NLR and PLR levels may predict BD. Although NLR, and PLR are higher in BD patients, no differences were found when comparing patients with and without ocular involvement. The MPV may be a simple, inexpensive, and convenient diagnostic marker of active ocular BD.

Is There an Association between Restless Legs Syndrome and Urticaria

Restless legs syndrome (RLS) is a disease characterized by the urge to move the legs and sleep disturbances. Similarly, chronic spontaneous urticaria (CSU) is a dermatological disease characterized by pruritus and sleep disorders. In this study, we aimed to determine the prevalence and severity of RLS in patients with chronic spontaneous urticaria (CSU) and to compare the quality of sleep of patients with and without RLS in the CSU group using the Pittsburgh Sleep Quality Index. A total of 130 patients with CSU and 100 healthy controls were included in this study. The frequency of RLS, frequency of sleep disturbances, and average score of RLS in patients with CSU were statistically significantly higher than control groups (respectively P = 0.008, P = 0.009, P = 0.004). Subjective sleep quality, sleep latency and habitual sleep efficiency scores in patients with RLS were statistically significantly higher than patients without RLS (respectively P = 0.016, P = 0.007, P = 0.035). We claimed that pruritus of urticaria may decrease the quality of sleep in patients with RLS and it may trigger and worsen the restless legs syndrome. Furthermore, RLS and CSU may share a common etiology.

The Comorbidity of Morphea, Raynaud's Phenomenon and Sarcoidosis: Case Report

106 arcoidosis is a multi-systemic disease which is characterized by noncaseating granulomas and usually affected lungs and intrathoracic lymph nodes. Sarcoidosis may present with three different clinical manifestations; asymptomatic sarcoidosis, sarcoidosis with non-specific symptoms and sarcoidosis with symptoms associated with specific organ involvement. Approximately 30-50% of patients are asymptomatic at the time of diagnosis and usually detected with routine chest radiography. Sarcoidosis, which is not clear whether it is an autoimmune disease or not, can be accompanied with autoimmune diseases. The Comorbidity of Morphea, Raynauds Phenomenon and Sarcoidosis: Case Report