Vural Kavuncu

Clinical Effectiveness of Aquatic Exercise to Treat Chronic Low Back Pain: A Randomized Controlled Trial

Study Design. This study was a prospective, randomized, controlled study. Objective. To compare the effectiveness of aquatic exercise interventions with land-based exercises in the treatment of chronic low back pain (CLBP). Summary of Background Data. Land-based exercise and physiotherapy are the main treatment tools used for CLBP. Clinical experience indicates that aquatic exercise may have advantages for patients with musculoskeletal disorders. Methods. A total of 65 patients with CLBP were included in this study. Patients were randomly assigned to receive aquatic exercise or land-based exercise treatment protocol. Aquatic exercise program consisted of 20 sessions, 5 × per week for 4 weeks in a swimming pool at 33°C. Land-based exercise (home-based exercise) program were demonstrated by a physiotherapist on one occasion and then they were given written advice The patients were assessed for spinal mobility, pain, disability, and quality of life. Evaluations were performed before treatment (week 0) and after treatment (week 4 and week 12). Results. In both groups, statistically significant improvements were detected in all outcome measures (except modified Schober test) compared with baseline. However, improvement in modified Oswestry Low Back Pain Disability questionnaire and physical function and role limitations due to physical functioning subpart of Short-Form 36 Health Survey were better in aquatic exercise group (P < 0.05). Conclusion. It is concluded that a water-based exercises produced better improvement in disability and quality of life of the patients with CLBP than land-based exercise.

The prevalence of obstructive sleep apnoea syndrome in ankylosing spondylitis patients

OBJECTIVE To assess the prevalence of obstructive sleep apnoea syndrome (OSAS) in AS patients. METHODS Thirty-one patients with AS were included in the study. The demographic data, spinal mobility measures and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores were recorded for each patient. All participants underwent one night of sleep recording, which was performed using a polysomnography (PSG). Pulmonary function test (PFT) was performed for all subjects and symptoms of OSAS were questioned. RESULTS Seven (22.6%) of 31 AS patients had OSAS according to PSG assessments. The mean BMI, disease duration, BASDAI score, neck circumference and occiput-wall distance were higher in patients with OSAS, but the differences were not significant. The mean ages of patients with OSAS were significantly higher than the patients without OSAS. The prevalence of OSAS in patients under the age of 35 years was found to be 6.3%, whereas the prevalence of OSAS in patients at the age of 35 years or over was 40.0% (P = 0.037). The prevalence of OSAS in AS patients with a disease duration <5 years was 11.8% and its prevalence in AS patients with a disease duration of >or=5 years was 35.7% (P = 0.198). PFT was restrictive in 16 (53.3%) patients and obstructive in none. CONCLUSIONS The prevalence of OSAS in AS patients is higher than reported in the general population. The diagnosis of OSAS should be kept in mind and OSAS symptoms should be considered especially in AS patients at the age of >or=35 years and in AS patients with a disease duration of >or=5 years.

The role of systemic hypermobility and condylar hypermobility in temporomandibular joint dysfunction syndrome

Objective: To evaluate the risk of temporomandibular joint dysfunction (TMD), when both systemic joint hypermobility (SJH) and localized condylar hypermobility (LCH) exist. Materials and methods: Sixty-four consecutive outpatients with temporomandibular joint clicking or pain, and 77 sex- and age-matched control subjects, were recruited in the study. LCH was diagnosed when condylar subluxation was present, and SJL was diagnosed by using Beighton’s method. The frequency of symptoms, mean mouth opening, and the frequency of subjects with SJL and LCH were the main outcome measures. Results: Out of the 64 patients, 16 patients were suffering from pain, 20 patients from joint-clicking and 28 patients from both. Both SJH and LCH were more frequently observed in those patients with TMD than in control subjects. The risk of TMD was higher if LCH and SJH existed jointly. Conclusion: Both systemic and localized hypermobility may have a role in the etiology of TMD.

Hearing and cochlear function of patients with ankylosing spondylitis

Ankylosing spondylitis (AS) is a chronic systemic inflammatory disorder that primarily affects the spine and sacroiliac joints. Recent studies described audiovestibular impairment in AS patients. The aim of this study was to evaluate the hearing and function of the cochlear system in patients with AS. Thirty-seven AS patients and 20 healthy controls were evaluated prospectively. Otorhinolaryngologic examinations were performed in all patients together with pure tone audiometry, speech discrimination test, tympanometry, and distortion product otoacoustic emission (DPOE). Disease duration, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores, and hematologic findings (CRP and ESR) were also collected. Pure tone audiometry findings of the patients and controls were significantly different in all frequencies (p < 0.01). Speech discrimination scores were also significantly different (p < 0.01). No significant difference was found between DPOE responses of the patients and controls (p > 0.05). There was no correlation between disease duration, BASDAI scores, hematological findings, and audiometry findings (p > 0.05). This study demonstrated that there is an association between AS and hearing loss, but the cochlea is not the main source of hearing loss.

Effects of balneotherapy with exercise in patients with low back pain

Low back pain (LBP) is an important clinical, social, and public health problem. Balneotherapy is a type of therapy by hot or warm waters containing minerals. The aim of this study was to investigate the effects of balneotherapy with exercise on pulmonary functions, aerobic exercise capacity, resting metabolic rate, body fat %, psychosocial condition and its efficiency on therapy in patients with LBP. Balneotherapy and exercise program were applied to group 1 (14 female, 9 male). Only an exercise program was applied to group 2 (13 female, 8 male). The measurements of maximal oxygen consumption, resting metabolic rate, pulmonary function tests, body fat %, Oswestry disability index, visual analog scale, quality of life measure, symptom checklist-90-revised, the hospital anxiety and depression scale, spine joint mobility tests from all participants were performed before and after the treatment. An improvement was found in pulmonary function test (maximal volunteer ventilation), aerobic exercise capacity, pain and disability scores, spine mobility (extension distance), quality of life, and all psychiatric symptoms (except anxiety) in group 1 following therapy period. Also some improvements were observed in body fat percentage, pulmonary function tests (forced vital capacity, forced expiratory volume in 1 second, forced expiratory flow at 25% to 75% vital capacity and peak expiratory flow), and other spine joint mobility tests before and after therapy in group 1, though they were not statistically significant. Balneotherapy with exercise could be alternative therapy methods in patients with LBP.

Markers of autoimmune liver diseases in postmenopausal women with osteoporosis

INTRODUCTION: Osteoporosis is a common complication of chronic liver diseases. However, there is limited information about autoimmune liver diseases as a factor of secondary osteoporosis. Therefore, we aimed to investigate the autoantibodies of autoimmune liver diseases in patients with osteoporosis. METHODS: One hundred fifty female patients with postmenopausal osteoporosis were included. Bone mineral density was measured by dual energy X‐ray absorptiometry. We analysized autoantibodies including antinuclear antibodies, liver membrane antibodies, anti‐liver/kidney microsomal autoantibodies1, liver‐specific protein, anti‐smooth muscle antibodies, and anti‐mitochondrial antibodies by indirect immunofluorescence. Serum was assayed for the levels of aminotransferases. RESULTS: The mean age of the patients was 63,13±8,6 years. The mean values of L1‐L4 T‐scores and femur total T‐scores were ‐3,08±0,58 and ‐1,53±0,81, respectively. Among the 150 patients with osteoporosis, 14 (9.3%) were antinuclear antibodies, four (2.7%) were liver membrane antibodies, three (2.0%) were anti‐liver/kidney microsomal autoantibodies1, and two (1.3%) were liver‐specific protein positive. None of the patients had anti‐mitochondrial antibodies or smooth muscle antibodies positivity. The mean values of levels of aminotransferases were within normal range. CONCLUSIONS: The presence of liver membrane antibodies, liver‐specific protein, and anti‐liver/kidney microsomal autoantibodies1 has permitted us to see that there may be some suspicious clues of autoimmune liver diseases in patients with osteoporosis as a secondary risk factor. On the other hand, there is a need for comprehensive studies with a larger sample size and studies designed to compare the results with a normal population to understand the clinical importance of our findings.

Demodex folliculorum in patients with rheumatoid arthritis

The objective of this study was to investigate the incidence and density of Demodex folliculorum in the patients with rheumatoid arthritis (RA). Forty-one patients with RA and twenty-seven age and sex matched healthy controls were enrolled in this study. Disease Activity Score (DAS 28) was used for the assessment of disease activity. Out of 41 patients, 33 were females and 8 males. The mean disease duration was 10.9 ± 8.2 years. The mean DAS 28 was 3.8 ± 1.2. No statistically significant differences in the incidence and density of Demodex mites were found between patients with RA and controls. Although immunosuppression is thought to be a risk factor for the D. folliculorum infestation no such correlations could be found in the 41 immunosuppressed patients with RA, therefore, further studies with larger groups are needed.

Evalution the Effects of Raloxifene and Risedronate on Serum Biochemical Markers

Summary Objective: Osteoporosis a progressive bone disease that is characterized by a decrease in bone mass which can lead to an increased risk of fracture. Osteoporosis is still a global public health problem. In recent years, many new osteoporosis drugs have become available but none of them is totally curative. The aim of the present study was to evaluate and compare the effects of risedronate and raloxifene on bone mineral density (BMD) and bone turnover markers. Materials and Methods: A total of ninety patients with postmenopausal osteoporosis were randomly divided into three groups receiving calcium-vitamin D plus raloxifene, calcium-vitamin D plus risedronate, and only calcium-vitamin D (control group). Serum osteocalcin and collagen type 1 cross-linked C-telopeptide (CTX) were measured before treatment and after 3, 6, 9 and 12 months of treatment. BMD was measured by Dual-Energy X-Ray absorptiometry (DEXA) before treatment and after 12 months of treatment. Results: Serum CTX levels were decreased significantly (p<0.001) in all groups from baseline to post therapy of 3 months and this decrease continued to the end of the study. Serum osteocalcin levels were decreased significantly (p<0.001) in treatment groups compared to control group. L1-L4 and femur total BMD was statistically lower in treatment groups compared to control group after 12 months of the therapy (p<0.001 and p<0.05, respectively). Conclusion: The results of the present study showed us that risedronate and raloxifene were both effective on bone mineral density and the effect of both of them to do not differ not from each other in the treatment of osteoporosis. (Turkish Journal of Osteoporosis 2014;20: 110-6)

Evaluation of Hearing and Cochlear Function in Patients with Ankylosing Spondylitis

Objective: Ankylosing spondylitis (AS) is a chronic systemic inflammatory disorder that primarily affects spine and sacroiliac joints. Recent studies described audiovestibular impairment in AS patients. The aim of this study was to evaluate the hearing and function of cochlear system in patients with AS. Method: We prospectively evaluated 37 AS patients and 20 healthy controls. Otorhinolaryngologic examinations were performed in all patients together with pure tone audiometry, speech tests, tympanometry, and distortion product otoacoustic emission (DPOE). Disease duration, Basdai scores, and hematolgic findings (CRP, Sedimentation) were also collected. Results: Pure tone audiometry findings and of the patients and controls were significantly different in all frequencies (P > .05). No significant difference was found between DPOE responses of the patients and controls (P > 0.05). Conclusion: This study demonstrated that there is an association between AS and hearing loss. But the cochlea is not the main source of hearing loss.