Yeşim Gökçe Kutsal

Polypharmacy in the elderly: a multicenter study.

OBJECTIVE The aim of this study was to evaluate the polypharmacy issue and its correlations with socioeconomic variables in Turkish elderly patients. DESIGN Cross-sectional SETTING Outpatient clinics of the medical schools, departments of physical medicine and rehabilitation from 12 provinces. PARTICIPANTS A total of 1430 elderly in different geographical regions of Turkey during January 2007 to January 2008 were included. MEASUREMENTS Patients were interviewed using a questionnaire that included demographic characteristics, current medical diagnosis, and pharmaceuticals that are used by elderly. Demographical parameters were gender, age, marital status, number of children, level of education, province, and status of retirement. RESULTS The mean number of drugs was found to be higher in the females. There was a significant difference among age groups, marital status groups, and the number of children categories. The distribution of the number of drugs among education levels did not differ significantly, whereas the distribution of the number of drugs between the status of retirement and presence of chronic disease differed significantly. CONCLUSIONS Polypharmacy is correlated with various factors including age, sex, marital status, number of children, status of retirement, and presence of chronic medical conditions but not educational status in our study group.

Awareness of osteoporotic patients

Osteoporosis has recently been recognized as a major public health problem by some governments and health care providers. Despite significant progress in knowledge about osteoporosis, public awareness is required for effective management if precautions are to be taken. The aim of this study was to evaluate the educational status of osteoporotic individuals, and their awareness about the disease and sources of information. We also aimed to compare the variables between the geographical regions of the country, since significant differences exist in socioeconomic status and lifestyle within the same cultural context. This multicenter study was carried out in eight cities located in six different geographical regions between September 2001 and January 2002. To our knowledge, this is the first multicenter study in Turkey evaluating the relationship between awareness of osteoporotic patients and other variables such as educational level and economic factors. Ten centers took part in this study and consecutive patients with either femoral or lumbar T-scores below −2.5 SD were enrolled into the study group. Bone mineral density was measured using dual energy X-ray absorptiometry (DXA). Patients were interviewed using a questionnaire on past medical history, education, awareness about their disease and risk factors for osteoporosis. A total of 540 women (93.8%) and 36 men (6.3%) were included in the study. Fifty-four percent of patients declared that they were aware of osteoporosis. With regard to sources of information, 56.8% of patients reported physicians as the main source of information. Awareness of the patients was negatively correlated with age (P=0.025, r=−0,94) but positively correlated with education (P=0.0001, r=0.327), level of physical activity (P=0.001, r=143), calcium intake (P=0.005, r=119) and modern clothing style (P=0.0001, r=309). Educational status of the patients was negatively correlated with BMI (P=0.0001, r=−283) and positively correlated with physical activity (P=0.0001, r=268), modern clothing style (P=0.0001, r=600) and smoking (P=0.0001, r=273). Regional comparison of female patients demonstrated that significant differences exist in terms of educational status, clothing style, smoking, level of physical activity, calcium intake, and knowledge about osteoporosis. As a result, education has profound effects on awareness about osteoporosis and many aspects of human behavior, such as calcium intake, physical activity, clothing style and smoking. Significant disparities may be observed between the geographical regions of the same country.

Effect of muscle relaxation splint therapy on the electromyographic activities of masseter and anterior temporalis muscles.

The purpose of this study was to compare the effectiveness of splint therapy on the electromyographic activity of masticatory muscles (anterior temporalis and masseter) before and after the application of a muscle relaxation splint. Electromyography recordings from the masseter and anterior temporalis muscles were analyzed quantitatively during maximal biting in the intercuspal position both before and after treatment without a splint. Fourteen patients whose chief complaint was masticatory muscle pain were selected for the study. After the initial evaluations muscle relaxation splints were applied, and the patients were instructed to use the splints for 6 weeks. Surface electromyographic recordings were taken from each patient before the beginning of clinical therapy and after 6 weeks of wearing the splints. The data obtained were analyzed through paired sample t tests and Wilcoxons signed rank tests. The results of the study were as follows: (1) the electromyographic activity of the two muscles during maximal biting was not markedly changed after the muscle relaxation splint was used; and (2) the changes observed in electromyographic activity of the involved and noninvolved sides were insignificant as well.

The frequency of fibromyalgia in sport professionals

Fibromyalgia is a chronic musculoskeletal disorder characterized by widespread pain and tenderness at specific anatomic sites, commonly accompanied by fatigue [1]. The etiopathogenesis of fibromyalgia is probably multifactorial and peripheral, and central factors are thought to interact with the development of this syndrome. The true incidence and prevalence of fibromyalgia is unknown. However, studies from North America and Europe have revealed overall prevalence rates ranging from 1 to 5% in the general population [2]. It is well known that many individuals with fibromyalgia are typically inactive and deconditioned [3, 4]. Thus, various forms of exercises are increasingly recommended to these patients as an integral part of nonpharmacological treatment. Aerobic and muscle strengthening exercises are shown to be effective at improving symptoms, tender point counts, pain threshold, physical fitness and quality in fibromyalgia [5]. Professional athletes regularly perform exercise programs designed to improve and maintain their physical fitness. Therefore, it can be expected that the prevalence of fibromyalgia in adults participating in competitive sports is to be lower than that in general population. The aim of this study was to determine the frequency of fibromyalgia in a population of sport professionals. One hundred and eighty-five sport professionals (74 women, 111 men) were enrolled in the study. Each of the participants was asked whether he or she had widespread pain over the last 3 months. If the answer was yes, then the duration and severity of pain were recorded. In the physical examination, 18 tender points identified by the 1990 American College of Rheumatology (ACR) criteria for the diagnosis of fibromyalgia were palpated, and the subjects’ responses were noted. Statistical analyses were performed by using the SPSS version 11.5 for Windows package program. Results were expressed as mean ± standard deviation. Mann–Whitney U test was used for comparison of the duration and severity of pain. Statistical significance was determined at P value \ 0.05. Fifty-nine participants (64.4% of them were men) with a mean age of 23.9 ± 4.9 years had declared that they have widespread pain. The mean duration of pain was 37.8 ± 39.3 (median 24) months. The mean value of pain severity marked on a 10-cm visual analog scale was 42.5 ± 21.2 mm. There were no significant differences between genders in the duration and severity of widespread pain. Six of the individuals with widespread pain had no tender points, whereas the average number in the ones who had at least one tender point was 5.5 ± 3.7 (1–18). Eleven or more of the 18 tender points were detected in 12 subjects. However, only 4 of them suffered from widespread pain and diagnosed with fibromyalgia. To the best of our knowledge, only one study has been previously conducted to determine the prevalence of fibromyalgia in young healthy athletes. Andary et al. evaluated 641 college student athletes and found that only F. _ Inanici O. Ozdemir Y. G. Kutsal Z. Hascelik Department of Physical Medicine and Rehabilitation, Hacettepe University Medical School, Ankara, Turkey

Effect of Anterior Repositioning Splints on the Electromyographic Activities of Masseter and Anterior Temporalis Muscles

The effect of anterior repositioning (AR) splint therapy on masticatory muscle activity was investigated in seventeen patients with internal derangement; disk displacement with reduction in particular. Integrated electromyography (EMG) recordings from the masseter and anterior temporalis muscles were analyzed quantitatively during maximal biting in intercuspal position before and after eight week treatment period, EMG recordings were taken for each subject prior to the beginning of clinical therapy and final EMG recordings were made without AR splint to provide a standard for comparison. The results of the investigation revealed the following: 1. AR splint therapy did not cause any significant modification of the EMG activity in the recorded muscles during maximal biting in intercuspal position; 2. Before and after treatment the EMG activity from the masseter muscle was less than from the temporal muscle; 3. AR splint therapy resulted in reduction of the pain (88.2%) and jaw joint sounds (64.7%) and mean vertical opening which was 42.17 mm before treatment increased to 45.06 mm.

The relationship between body mass index and footprint parameters in older people

BACKGROUND The relationship of body mass index (BMI) with footprint parameters has been studied in paediatric populations, but there are limited data regarding the effects of BMI on parameters in the elderly. OBJECTIVES To establish the relationship between BMI and static footprint parameters in the elderly population. METHODS 128 subjects aged 65 and above with no history of lower extremity surgical intervention and no significant lower extremity weakness were included in the current study. BMI and footprint parameters of arch angle, Chippaux-Smirak index (CSI), Staheli index (SI), arch index (AI) and footprint index (FI) were measured for each subject, and statistical analysis was done to investigate the correlation between BMI and the parameters. RESULTS Weak correlations detected between all calculated indices and angles with BMI, except the left foot arch angle. CSI, SI and AI of the right foot were found to be positively correlated with BMI, while a negative correlation between the arch angle and FI of right foot was shown with BMI. CONCLUSIONS The results reveal a relationship between BMI and footprint parameters that are indicative of flatfoot in the elderly. This could be due either to confounding of the footprint measure by fat or possibly due to an as yet unknown structural change that requires further evaluation.

Reversible sclerotic changes of lumbar spine and femur due to long-term oral isotretinoin therapy

We present a rare case of retinoid-induced sclerotic changes of lumbar spine and femur demonstrated by dual energy x-ray absorptiometrie (DEXA). The patient had flowing ossification along thoracic spine resembling diffuse idiopathic skeletal hyperostosis (DISH), but there was no ligament calcification in the lumbar spine or pelvis. After discontinuation of the treatment, gradual decline of bone mineral density at lumbar and femoral sites was detected with serial DEXA measurements. To the best of our knowledge, although various abnormalities of bone due to retinoids have been described before, reversible sclerotic changes have not been reported.

Biogerontology in Turkey: a brief report

In this brief report, aging in biogerontology science perspective has been discussed based on the Turkish literature review with major key recommendations for future studies. Biogerontology in Turkey has focused on general retardation of the aging process giving priority to caloric restriction and oxidative stress mechanisms. The most popular investigation area for the scientists has been the oxidant and anti-oxidant systems in different tissues. However, the Turkish biogerontology science needs more manpower, economical and infrastructural and other resources for the promising studies in the future.

A DESIGN OF TREADMILL FOR RATS

Research related to the effects of exercise on musculoskeletal system has increased significantly in recent years. We designed and constructed a cheap and hand-made treadmill with adjustable speeds that enabled us to exercise our rats with constant speed. We aim to help researchers with limited funding construct their own treadmills they may need for exercise studies.