Tuba Tülay Koca

A brief summary of clinical types of psoriasis

Psoriasis is a chronic inflammatory dermatosis that is thought to onset as a result of T lymphocyte-mediated immunological response. Disease may manifest itself in different modalities with regard to clinical features and severity. Clinical type of psoriasis is an important element in determining the therapy regimen. This article reviews clinical types of psoriasis.

Evaluation of sleep disorder and its effect on sexual dysfunction in patients with Fibromyalgia syndrome

Objective: Sexual problems are commonly seen in women with fibromyalgia syndrome (FMS). The objective of this study was to reveal the relationship between the severity of symptoms, sleep disorder, and sexual dysfunction in women with FMS. Materials and Methods: A total of 140 sexually active women with FMS aged 17-67 years who presented to our physical medicine and rehabilitation outpatient clinic between January 2016 and June 2016 were enrolled in the study. The patients’ age, height, body weight, body mass index (BMI), and general pain score [visual analogue scale, (VAS)] for the last 1 week were recorded. The patients were given three different sets of questionnaires: the Pittsburgh Sleep Quality Index (PSQI), Fibromyalgia Impact Questionnaire (FIQ), and Female Sexual Function Index (FSFI). Results: The mean age of the patients was 40.3±8.5 years; the mean BMI was 27.1±4.4 kg/m2, VAS (last 1 week) was 6.9±2 cm, the mean PSQI was 24.8±10.8 (one patient with PSQI ≤5), FIQ was 65.9±19.2, and FSFI was 19.0±6.9. No significant relationship was observed between the mean PSQI and BMI values (p=0.401), whereas a significant relationship was found between the mean values of VAS, FIQ, and FSFI (p=0.03; p=0.034; p<0.001, respectively). In Pearson’s correlation analysis, a positive correlation was noted between PSQI and VAS (r=0.324; p<0.001) and FIQ values (r=0.271; p=0.001). A significant relationship was found between the FIQ and VAS values (p<0.001). P less than 0.005 was considered statistically significant. Conclusion: Sleep disorder is regarded as the underlying cause for many signs and symptoms in FMS. Sexual dysfunction may develop in women with FMS, based on the severity of the disease and poor sleep quality. We found that sleep dysfunction was significantly related with the severity of disease, pain, and sexual disfunction. We also found a positive correlation between VAS and PSQI.

Results of a compression pin alongwith trochanteric external fixation in management of high risk elderly intertrochanteric fractures

Background: External fixation is a well-known procedure for the management of intertrochanteric fractures in very elderly high-risk patients. A new compression pin that can be adapted to all fixators was designed to provide inter fragmentary compression. In the present study, its effects on the fracture stability and healing were evaluated. Materials and Methods: Thirty-one patients treated using compression pin and thirty-six patients treated using standard pins were evaluated retrospectively between January 2009 and July 2014. Patients were evaluated according to age, gender, duration of preoperative period, duration of operation time, American Society of Anesthesiologists (ASA) scores, and immediate postoperative and final femoral neck angle measurements. The stability of the fixation was evaluated by calculating the secondary varus angulation after weight bearing. Results: Thirty one patients (82.1 ± 6.1 years old) comprised the compression pin group, and 36 patients (83.33 ± 6.24 years old) comprised the standard pin group. From the time of weight bearing to healing time, 1.0 ± 1.25° (0–4) and 2.5 ± 1.8° (0–9) of secondary varus angulation in the compression pin and standard pin groups were measured, respectively (P = 0.000). With weight bearing, 2 of 31 (6%) and 9 of 36 (25%) patients in the compression and standard pin groups, respectively, had >4° of secondary varus angulation. In the compression pin group, 13 fractures were unstable, but only 2 (15%) of them had >4° of secondary varus angulation. In the standard pin group, 19 fractures were unstable, and 7 (37%) of them had >4° of secondary varus angulation. Conclusions: Treatment of very elderly, high risk patients’ with intertrochanteric fractures with external fixation is effective. Compression pin maintained stability better than standard pins after weight bearing, especially for unstable intertrochanteric fractures.

Is it Possible to Recover Cardiac Functions After Total Knee Arthroplasty

Background: Patients suffering from knee osteoarthritis lead a less active life than their healthy peers. It is well known that insufficient physical activity is the most common cause of chronic diseases. However, there is not enough research to enlighten the effect of increased functional capacity on cardiac functions after Total Knee Arthroplasty (TKA). This study aimed to investigate whether the orthopedic surgeons can predict that the patients will be healthier after TKA in terms of cardiac functions or not? Methods: 109 patients who underwent TKA were prospectively followed for one year. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and short form 36 (SF-36) surveys, BMI measures, average step count per day, the six-minute walking test (6MWT), the Five-Times-Sit-to-Stand Test (FTSST) and Doppler echocardiography were performed both in the preoperative and postoperative period. Results: After TKA, there was a substantial improvement in terms of WOMAC and SF36 survey scores. The average step count increased from 2199.6±690.8 steps/day to 4124.3±1638.8 steps/day. 6MWT and FTSST improved significantly as well. The average brisk walking time was 174.23±95.11 minutes/week. The means of early and late mitral inflow velocity ratios (E/A and Em/Am ratios) increased from 0.71±0.12 to 0.77±0.13 and from 0.66±0.13 to 0.76± 0.15 at the first year follow-up visit, respectively (p<0.001). Conclusion: In the first year, objective physical capacity measures increased together with the expected improvements in disease-specific and generic measures. After TKA, left ventricular diastolic functions may be considered to have recovered in the light of the healing signs via echocardiography.

Complications in patients with spinal cord injuries: a clinical study from a third level rehabilitation center in Turkey

Objectives: Normal lifespan can be achieved by avoiding complications in patients with spinal cord injuries (SCIs). We aimed to characterize our spinal cord injured patients and to obtain necessary information to prevent complications. Methods: This retrospective, cross-sectional study included 44 patients with subacute/chronic SCIs, who were included in an inpatient rehabilitation program from 2012 to 2017. The patients’ epidemiological data, etiology, neurological examinations, complications, and accompaying conditions were analyzed. The neurological level, functional ambulatory scale (FAS), and American Spinal Cord Injury Association (ASIA) impairment scale were used for the classification of patients. Results: A total of 44 patients between 16 and 81 years of age (median: 35) were included in the study. Of these, 65.9% were male. The most common etiologies were falling down from a height (31.8%), spinal surgery (29.5%), and traffic accidents (15.9%) respectively. When we look the neurological status of these patients, FAS: 0 (38.6%) and ASIA: C (40.9%) were the most common cases seen in the population. Eighteen patients (40.9%) were wheelchair-bound. Urinary (34.1%), dermatologic (29.5%), and psychiatric (22.7%) complications were the most common in the patients. Patients with low FAS levels were young (in early period), and their spasticity, urinary incontinence, and urinary and dermatological pathologies were found to be high. The wheelchair-bound patients were mostly young, and they had significantly high urinary incontinence, urinary and dermatological pathologies. Conclusions. In our rehabilitation clinic, subacute/chronic SCI diagnosis is most commonly seen in young men, with thoracic vertebrae being the most common, followed by falling from a height. The most common complications were urinary and dermatological pathologies. The present study found higher rates of complications in patients with higher grades of injuries and in patients with lower functional levels.

Magnetic resonance imaging evaluation of the median nerve using histogram analysis in carpal tunnel syndrome

Corresponding Author: Tuba Tülay Koca E-mail: tuba_baglan@yahoo.com Submitted: 05 May 2018 Accepted: 26 August 2018 You may cite this article as: Baykara M, Koca TT, Demirel A, Berk E. Magnetic resonance imaging evaluation of the median nerve using histogram analysis in carpal tunnel syndrome. Neurol Sci Neurophysiol 2018; 35(3): 145-150. Abstract Objective: Histogram analysis of digital images is a popular new tissue analysis method. It has recently attracted much attention, is used to describe prognostic biomarkers, to characterize tumors, and to assist a few applications that guide radiotherapy treatment. Here, magnetic resonance imaging (MRI) measurements of the median nerve in the carpal tunnel of patients with carpal tunnel syndrome (CTS) were analyzed.

The relationship between vitamin D level and disease activity and focal erosion in rheumatoid arthritis

Aim: Bone loss,fragility,and fractures are well-described complications that affect quality of life, morbidity, and health care costs during the course of rheumatoid arthritis (RA). Besides its well-known role in bone metabolism, vitamin D is also an important immune modulator, meant to affect the disease activity of rheumatic disorders. However, conflicting results have been demonstrated about the relationship between levels of vitamin D and disease activity in RA. Primary aim of was to compare vitamin D levels and Bone Mineral Density (BMD) values between RA and control groups.The secondary aim was to assess the correlations between vitamin D and disease activity and radiologic damage in RA. Material and Methods: A total of 41 RA patients and 40 healthy controls were included in this study. The patient and control groups were between the ages of 18 and 65. Disease activity score 28 (DAS-28) was used to determine the severity of disease.Sharp/van der Heijde method was performed to evaluate the radiologic changes.Dual energy X-ray absorptiometry (DEXA) was performed to measure Bone Mineral Density (BMD).Enzyme-Linked Immunosorbent Assay (ELISA) method was used to measure serum D vitamin concentrations. Results: Vitamin D levels, the BMD-lumbar spine, BMD-femur total and BMD-femur neck values were significantly lower in the patient group (p = 0.012, p < 0.001, p < 0.001 and p < 0.001). No significant correlations were detected between vitamin D levels and BMD values, disease activity, and radiologic damage scores (p > 0.05). DAS-28 was significantly and negatively correlated with BMD values (p < 0.05). Conclusion: Our study suggests that RA patients have lower vitamin D levels, BMD-lumbar spine, BMD-femur total and BMD-femur neck values. Higher disease activity increases bone loss in RA. Vitamin D levels and BMD values should be monitored for the risk of osteoporosis and fracture in RA.

The relation of body image perception with body mass index, gender and disease activity in ankylosing spondylitis and rheumatoid arthritis

Aim: Ankylosing spondylitis (AS) and Rheumatoid arthritis (RA) diseases causes physical deformities and chronic pain which lead to impairment in the body image perception (BIP) of the body. Material and Methods: Sixty (N=60) AS patients and 55 RA patients were included into the study. Age, gender, body mass index (BMI), duration of diagnosis, education and disease activity of the patients were recorded. Results: At the mean age of 38.5 ± 9.8 years, 46 male (M) and 14 female (F) patients with AS were included in the study. In patients with AS, BIP score was positively correlated only with peripheral joint involvement (r = 0.32 / p = 0.005). At mean age of 52.1 ± 13 years, 12 male and 43 female patients with RA were included. The BIP score in RA patients did not correlatewith any parameter. The BIP score was not significantly different between the two groups. In the AS group, BIP score was significantly higher in female gender (F = 110.2 ± 29 / M = 95.8 ± 20.5; p = 0.041). In the whole group only in male gender BIP score was negatively correlated with duration of diagnosis (r = -0.264, p = 0.047); it was positively correlated with BASFI (r = 0.306; p = 0.041). Conclusion: In the early active periods of the rheumatologic diseases and in the later stages of them with the progress of physical disability, BIP may get worse. A better understanding of factors affecting BIP will increase the success of treatment regimens.

Clinical features of patients diagnosed with degenerative rotator cuff tendon disease: a 6-month prospective-definitive clinical study from turkey

[Purpose] In rotator cuff tendon disease (RCTD), anamnesis is as important as clinical findings and anatomic/radio diagnostic examination. This study aimed to investigate the clinical features of patients diagnosed with RCTD using clinical and radiological methods between March 2015 and August 2015 at Malatya Research and Training Hospital Physical Medicine and Rehabilitation department. [Subjects and Methods] The study included 178 patients who were diagnosed with RCTD (128 females and 50 males). A questionnaire comprising 33 questions was given to each patient. [Results] Eighty-eight of the patients (49.9%) had an involvement on their right side, eighty-four (47.1%) had an involvement on their left side, and 6 had bilateral involvement. Mean visual analog scale (VAS) score was found to be statistically significant in favor of female patients. A statistically significant correlation was found between educational status and VAS. The body mass index (BMI) of the female patients was found to be higher than that of the male patients. Statistically significant correlation between doing risky work and gender showed that males were at a higher risk. [Conclusion] RCDT is more seen in people who have high BMI and are at their 50s. Pain complaint and BMI were found higher in female patients. DM, thyroid and cardiac diseases were seen more in the patients who are diagnosed with RCTD relative to the healthy population.

Is having O blood type a risk factor for Fibromyalgia syndrome? The importance of nutrition in Fibromyalgia syndrome

Aim: Fibromyalgia syndrome (FS) is characterized with diffuse pain and sensitivity at specific anatomical points and occurs together with mood, sleep and cognitive disorders. Life quality of the patients was destroyed and this situation creates an important economical issue in the medical care system. According to different antigens placed on the surface of red blood cells, there are four different blood type groups such as A, B, O and AB. To give nutritional recommendations for different blood types became one of the most popular topics in last decades. In this study, we investigated the link between FS and ABO blood types. Methods: In this study, we included 200 female patients with FS diagnosis (according to American College of Rheumatology, 2010 criteria) who visited our Physical Medicine and Rehabilitation Clinic between July 2015 and December 2015. The patients’ age, blood group, Rh antigen system were saved. Control group was also formed from 185 volunteer healthy female patients. P<0.05 was evaluated as statistically significant. Results: In our study, age distribution of FS group (N=200) was 40.6±10.8 and for control group (N=185), it was 43.0±14.8. In the control group, 58 people was A type (%31,4), 29 people was B type (%15.7), 23 people was AB type (%12.4) and 75 people (40.5%) was O type blood group according to ABO classification system. In the FS group, 60 people was A type (%30), 21 people was B type (%10.5), 10 people was AB type (%5) and 109 people (54.5%) was O type blood group according to ABO classification system. In both groups, a statistically significant difference was observed (p=0.03). There were more O type blood group carrying patients were detected in FS group. Conclusion: Most of the treatments used for FS are not effective. In order to decrease oxidative stress, weight management, nutritional condition, diet and nutrition supplement are important in these patients. To see more O type carrying people in FS group will guide us for etiopathogenesis, monitoring, clinical follow and treatment.