Şule Şahin Onat

Low bone density in achondroplasia

To the editor, A 39-year-old female achondroplastic patient was admitted to our outpatient clinic for her back and lower extremity pain. Her height and weight were 125 cm and 38 kg, respectively (Fig. 1). She had a body mass index of 24.3 kg/m. She had undergone leg lengthening on bilateral tibias when she was 12. On physical examination, she had bilateral paravertebral muscle spasm at her back. She also had painful hip internal rotation and knee flexion on both sides with bilateral positive Clarke’s sign. Her physical examination was otherwise noncontributory. X-ray examination revealed early degenerative changes, especially at the hip joints and strikingly osteopenia. On detailed questioning, it was understood that she had been advised to receive 300,000 IU vitamin D3 (the form of vitamin D available in our country) once a year and to exercise regularly for low bone density 2 years ago. The past two bone mineral density (BMD) measurements, performed by a single technician using dual-energy X-ray absorptiometry (DEXA) on a Lunar DPX-IQ scanner in our center, were analyzed, and a new BMD measurement was performed under similar conditions with the ones referred above (Table 1, Fig. 2). The laboratory tests was as follows: serum total calcium, 9.3 mg/dl (8.2–10.6); inorganic phosphate, 3.2 mg/dl (2.5–4.5); alkaline phosphatase (ALP), 47 U/l (30–126); type 1 collagen C terminal telopeptide (CTX), 0.253 (25–573); osteocalcin, 3.46 ng/ml (3.1–13.7); parathormone, 34.23 pg/ml (15–65), and vitamin D3, 20.1 ng/ml (>30). Risk factor examination for low bone density yielded no results. Low bone density was considered as a consequence of altered bone metabolism due to achondroplasia. She was prescribed 300,000 IU oral vitamin D3 and recommended to continue on her exercises. She was also included in a physical therapy program for her symptoms due to degenerative changes. Achondroplasia is the most common form of skeletal dysplasias. A spontan or inherited mutation in the fibroblast growth factor receptor 3 (FGFR3) gene on the fourth chromosome brings out the disease [1]. The primary defect is abnormal endochondral ossification [2]. It has a number of wellknown neuromusculoskeletal manifestations [3]. Recently, Arita et al. reported low bone density, diagnosed with spinal BMD analysis and panoramic radiographic measurements, in 5 of 11 achondroplastic patients for the first time in the literature [4]. To the best of our knowledge, our report is the second one referring the relationship between

Shall We Inject Superficial or Deep to the Plantar Fascia? An Ultrasound Study of the Treatment of Chronic Plantar Fasciitis

ABSTRACT We compared the effectiveness of ultrasound (US)‐guided corticosteroid, injected superficial or deep to the fascia, in patients with plantar fasciitis. Thirty patients (24 females [75%] and 6 males [25%]) with unilateral chronic plantar fasciitis were divided into 2 groups according to the corticosteroid injection site: superficial (n = 15) or deep (n = 15) to the plantar fascia. Patient heel pain was measured using a Likert pain scale and the Foot Ankle Outcome Scale (FAOS) for foot disability, evaluated at baseline and repeated in the first and sixth weeks. The plantar fascia and heel pad thicknesses were assessed on US scans at baseline and the sixth week. The groups were similar in age, gender, and body mass index (p > .05 for all). Compared with the baseline values, the Likert pain scale (p < .001 for all) and FAOS subscale (p < .01 for all) scores had improved at the first and sixth week follow‐up visits in both groups. Although the plantar fascia thickness had decreased significantly in both groups at the sixth week (p < .001 for both), the heel pad thickness remained unchanged (p > .05 for both). The difference in the FAOS subscales (pain, p = .002; activities of daily living, p = .003; sports/recreational activities, p = .008; quality of life, p = .009) and plantar fascia thickness (p = .049) showed better improvement in the deep than in the superficial injection group. US‐guided corticosteroid injections are safe and effective in the short‐term therapeutic outcome of chronic plantar fasciitis. Additionally, injection of corticosteroid deep to the fascia might result in greater reduction in plantar fascia thickness, pain, and disability and improved foot‐related quality of life. &NA; Level of Clinical Evidence: 2

The Impact of Depression on Quality of Life and Depression Related Factors in Patients with Spinal Cord Injury

Objective: The aim of this study was to examine the relationship between depression and demographic and clinical characteristics of the patients, and the effects of depression on quality of life (QoL) in patients within the first six months after spinal cord injury (SCI). Material and Methods: One hundred patients with traumatic SCI who underwent inpatient rehabilitation program were enrolled in the study. Demographic data, etiology of injury and duration of disease (days) were recorded for all patients. Neurological level (cervical, thoracal, lumbosacral) and lesion severity (complete, incomplete) were determined according to the American Spinal Injury Association Impairment Scale (AIS). The Functional Independence Measure was used to assess functionality, the 36-Item Short-Form Health Survey was used to evaluate QoL, and the Beck Depression Inventory was used to assess depression. Results: There was a relationship between depression and female gender, lower education level, type of caregiver, the presence of pain and sleep disturbances. No relation was found between depression and injury severity, level of injury, or extent of functional impairment. BDI scores were negatively correlated with most of the components of SF-36 quality of life scale. There was a statistically significant difference in SF 36-Mental Component Scores between the groups according to the depression severity. Cared by a foreign caretaker, having a sleep disturbance and pain were found to be associated independent risk factors with the presence of clinically significant depression. Conclusion: The results of this study demonstrate that gender, education level, type of caregiver, presence of pain and sleep disturbances are the major determinants of depression in patients within the first six months after SCI. Findings showed the importance of family support to care for patients in SCI rehabilitation. It is important to treat pain, sleep disturbance and depression together in an early period of rehabilitation to improve QoL.

Ultrasonographic measurement of the femoral cartilage thickness in patients with transfemoral amputation

OBJECTIVE To compare the distal femoral cartilage thickness of the non-amputee sides in patients who had unilateral transfemoral amputation with those of healthy subjects by using ultrasound. METHODS Thirty transfemoral amputees (27 male, 3 female) and 30 age-, sex-, and body mass index-matched healthy controls were included. Functional usage of the prosthesis was evaluated by using Houghton score. The cartilage thickness was measured from the following midpoints; medial femoral condyle (MFC), intercondylar area, and lateral femoral condyle. RESULTS Thirty patients with unilateral transfemoral amputation (mean age; 38.6 ± 9.5 years) and 30 healthy controls (mean age; 38.4 ± 9.4 years) were included. Although femoral cartilage thicknesses were found to be lower for all measurements in the amputees, the difference reached significance only in the MFC (p= 0.031). In the patient group, cartilage thickness values did not correlate with age, duration of amputation, daily walking time, stump length or Houghton score. CONCLUSION The distal femoral cartilage thickness seems to be decreased medially on the non-amputee sides of the transfemoral amputees when compared with the healthy subjects. Further studies concerning the follow-up designs, functional parameters and osteoarthritis scales are awaited.

The Awareness of Elderly about Osteoporosis: What about Our Elderly?

Objective: Osteoporosis (OP) and bone fractures that can result in pain, functional impairment and death are important public health problems for the elderly. The aim of our study was to asses the awareness and the information level about OP in the elderly. Materials and Methods: A total of 250 participants (203 were women, 47 were men) who were 65 years and older who presented to our outpatient clinic were included the study. Demographic data were recorded. A 26 item questionnaire was used in the assessment of information on the OP risk factors in 220 (88%) cases who reported that they are aware about OP. Questionnaires were filled with face-toface interview. Results: There was no significant difference between gender and age groups (<75 and ≥75 years) in terms of OP awareness. OP awareness of literate cases was significantly higher than that in illiterate cases (p=0.023). OP awareness of cases with living in urban areas was significantly higher than that in cases living in rural areas (p=0.003). The main sources of information about OP were physicians (48.6%) and television (39.5%). It was determined that most commonly known risk factors of OP were inadequate calcium intake, female gender, aging, menopause and lack of exercise while they did not have enough knowledge about other risk factors. Conclusion: OP awareness increases with high education level and urban life in elderly. In our country, visual media and doctors are the most important source of information due to the low level of education of elderly. This situation should be considered when creating an educational program about OP for the elderly. (Turkish Journal of Osteoporosis 2015;21: 69-72)

Geriatrik Hastalarda Unutkanlık mı? Demans mı?: Bir Olgu Nedeni ile

Forgetfulness and reduction of memory function in the elderly is common complaints. We have presented this circumstance because of taking attention to say demans without a detailed evaluation of these patients and to express the inconsistency on the medium exchanges on the hospitalized geriatric. (Turkish Journal of Osteoporosis 2013;19: 56-7)