Yuksel Ersoy

The relation between tooth loss and bone mass in postmenopausal osteoporotic women in Turkey: a multicenter study

Abstract. The purpose of this study was to investigate the associations of tooth loss with skeletal bone mass, years since menopause, educational level, current smoking status, dietary calcium intake, and number of pregnancies in postmenopausal osteoporotic women in Turkey. The study population consisted of 1171 postmenopausal women aged 40–86 years (mean age, 61.19 ± 7.28 years). A detailed history was obtained from all women, including relevant lifestyle parameters, risk factors, and measurements of weight and height. Women were separated into three groups according to the number of teeth remaining as group 1 (edentulous, 457 women), group 2 (10 or fewer teeth, 232 women), and group 3 (more than 10 teeth remaining, 482 women). There was no significant difference among the three groups in mean age and menopausal age (P < 0.05). Body mass index of group 1 was significantly higher than that of group 2 (P < 0.01). Educational level was significantly different between three groups: groups 1 and 2 (P < 0.001), groups 1 and 3 (P < 0.0001), and groups 2 and 3 (P < 0.001). Educational level was lowest in group 1 and highest in group 3. Despite a low ratio of cigarette smoking in general, a smoking habit was most prevalent in group 3 and least in group 2. The ratio of women receiving adequate calcium was significantly lower in group 1 than in other groups (P < 0.001); mean calcium intake was similar in all groups. The number of pregnancies was significantly higher in group 1 than in other groups (P < 0.001). Lumbar bone mineral density (BMD) of group 1 was significantly lower than that of groups 2 and 3 (P < 0.001). Although no significant difference was found between groups 1 and 3, femoral neck BMD of group 2 was less than in others, and differences between groups 1 and 2 and between groups 2 and 3 (P < 0.001) were significant. Lumbar bone mineral content (BMC) of group 1 was significantly lower than that of groups 2 and 3 (P < 0.001), and lumbar BMC in group 2 was significantly higher than in group 3 (P < 0.05). Femoral neck BMC in group 1 was significantly higher than in groups 2 and 3 (P < 0.001). In conclusion, lumbar BMD and BMC in the edentulous group were significantly lower, whereas femoral neck BMD and BMC were significantly higher in edentulous group compared with the others. Our findings indicated that improvement in lifestyle factors and nutritional strategies for the treatment and prevention of osteoporosis may have additional benefit in reducing tooth loss.

Pattern of Disease Onset, Diagnostic Delay, and Clinical Features in Juvenile Onset and Adult Onset Ankylosing Spondylitis

Objective. To assess the frequency of juvenile onset ankylosing spondylitis (JOAS) in Turkish patients with AS and to compare with adult onset AS (AOAS) in a cross-sectional study design. Methods. A total of 322 patients were recruited from the joint database of 5 university hospitals in eastern Turkey. Results. Patients with JOAS (n = 43, 13.4%) had significantly longer diagnostic delay (9.21 vs 5.08 yrs), less severe axial involvement and more prevalent uveitis (OR 2.92, 95% CI 1.25–6.79), and peripheral involvement at onset (OR 3.25, 95% CI 1.51–6.98, adjusted for current age; and OR 2.26, 95% CI 1.07–4.76, adjusted for disease duration). Patients with AOAS had higher radiographic scores and more restricted clinimetrics but similar functional limitations and quality of life. Conclusion. JOAS and AOAS had distinctive courses and Turkish patients with AS had similar features compared to other Caucasian patient populations.

Predictive Effects of Different Clinical Balance Measures and the Fear of Falling on Falls in Postmenopausal Women Aged 50 Years and Over

Background: Falls among the elderly are associated with a high morbidity and mortality and can involve high-cost medical interventions. The risk of falls often remains undiagnosed until an episode occurs but if the risk is high, preventative measures could be introduced. Objectives: This 6-month prospective study investigated whether different postural clinical measures and fear of falling (FOF) itself can predict future falls in postmenopausal women aged ≥50 years. Methods: 125 postmenopausal women were studied comparing the outcome of fallers vs. non-fallers within the 6-month follow-up study period. Clinical measures, history of falls and FOF data were determined at baseline and the number of falls and FOF were ascertained at the final visit or by telephone interview at 6 months. Results: Of the clinical measures investigated, the Falls Efficacy Scale International (FES-I) >26 points (OR = 7.28, per additional point, 95% CI 2.25–23.61, p = 0.001) and Berg Balance Scale (BBS) ≤52 points (OR = 4.77, per additional point, 95% CI = 1.15–19.82, p = 0.031) performed best in prediction of the future falls. Conclusions: Postmenopausal women aged ≥50 years who had FES-I scores >26 points and BBS ≤52 points should be examined for risk factors of future falls and offered preventative measures.

Clinical Effects of Platelet-Rich Plasma and Hyaluronic Acid as an Additional Therapy for Talar Osteochondral Lesions Treated with Microfracture Surgery A Prospective Randomized Clinical Trial

Background: Osteochondral ankle injuries commonly affect the dome of the talus, and these injuries are a common cause of athletic disability. Various treatment options are available for these injuries including intra-articular hyaluronic acid (HA) and platelet-rich plasma (PRP) injections. The purpose of this study was to compare the effects of HA and PRP as adjunct therapies after arthroscopic microfracture in osteochondral lesions (OCLs) of the talus. Methods: In this prospective, randomized blinded study, 40 patients with talar OCLs in their ankle joints were treated with arthroscopic debridement and a microfracture technique. Thirteen randomly selected patients received PRP, 14 patients received HA, and the remaining 13 patients received saline as a control group. The participants were assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) and visual analog pain scale (VAS) scores after a 15.3-month (range, 11-25 months) follow-up. Results: Postoperatively, all the groups exhibited significantly increased AOFAS scores and decreased VAS scores compared with their preoperative results (P < .005). The AOFAS scores were significantly increased in the PRP group versus the HA and control groups (P < .005), although the increased AOFAS scores in the HA group versus the control group were also significant (P < .005). Similar to the AOFAS scores, the decrease in the VAS scores was significantly lower in the PRP group versus the HA and control groups (P < .005). In addition, the HA group had significantly lower VAS scores than the control group (P < .005). Conclusion: Both PRP and HA injections improved the clinical outcomes of patients who underwent operation for talar OCLs in the midterm period and can be used as adjunct therapies for these patients. Because a single dose of PRP provided better results, we recommend PRP as the primary adjunct treatment option in the talar OCL postoperative period. Level of Evidence: Level I, prospective randomized study.

Lower extremity isokinetic muscle strength in patients with Parkinson’s disease

We evaluated lower extremity isokinetic muscle strength to determine affected muscle groups and their dependence on movement velocity, and to establish the relationship between muscle strength and clinical severity, as well as muscle strength and falls, in Parkinsons disease (PD). Twenty-five patients diagnosed with PD and 24 healthy volunteers were enrolled in this study. Lower extremity muscle strength was measured using an isokinetic dynamometer. Each participants clinical status was examined in accordance with the Unified Parkinsons Disease Rating Scale; fall history was also recorded. We observed a significant decrease in isokinetic muscle strength in the patient group, especially in both hip and knee flexors and extensors. Decreased muscle strength was independent of velocity, and correlated with clinical severity and falls. Movement velocity-independent lower extremity isokinetic muscle weakness has been observed in patients with PD, especially in the knee and hip joints. The evaluation of isokinetic muscle strength may be a useful tool for the assessment of clinical severity and falls in PD.

Cervical myositis ossificans traumatica: a rare location

Abstract. An unusual case of myositis ossificans traumatica lesion located in the paraspinal region is reported. Despite the contiguity of the lesion with the cervical vertebrae and ominous appearance of the biopsy material, the history of antecedent trauma and computed tomography findings allowed preoperative accurate diagnosis. To our knowledge, myositis ossificans traumatica located in the cervical paraspinal region is very rare.

Discrimination ability of ASDAS estimating disease activity status in patients with ankylosing spondylitis.

Objectives:  To investigate discrimination ability of the Assessment of Spondyloarthritis International Society (ASAS) endorsed disease activity score (ASDAS) versions evaluating low and high disease activity in an unselected group of patients with ankylosing spondylitis (AS).

Postural stability in patients with ankylosing spondylitis

Purpose. The aim of this study is to determine whether the postural changes in ankylosing spondylitis (AS) affected postural stability. Method. A total of 64 patients with a diagnosis of AS and 50 healthy volunteers were included in the study. The patients were divided into two groups according to a tragus-to-wall distance <15 cm (Group I, n = 30) and ≥15 cm (Group II, n = 34). The control group (Group III) consisted of 50 healthy volunteers. The postural stability was evaluated with the Biodex Stability System (BSS). The results of Antero-Posterior Stability Index (APSI), Medio-Lateral Stability Index (MLSI) and Overall Stability Index (OSI) were evaluated. Results. There were statistically significant differences between the three groups for OSI, APSI and MLSI. MLSI results were significantly different among patient groups. When Group II and the control group were compared, there were significant differences for OSI, APSI, and MLSI. Comparing Group I with the control group revealed a more significant difference for OSI, APSI, and MLSI. Conclusions. We have found that postural stability decreases in patients with AS in both the early and the late stages of the disease, but especially in the latter ones. This result may be thought to be related with increased kyphosis which is seen during the course of the disease.

Psychological status is associated with health related quality of life in patients with rheumatoid arthritis

Objective: Rheumatoid arthritis (RA) is a chronic and disabling disease frequently effects physical and psychological well being. The aim of the present study was to determine the impact of psychological status on health related quality of l ife in patients with RA and also to assess which quality of life (QoL) instrument - disease specific and generic - is more prone to t his effect. Methods: A total of 421 patients with RA recruited from joint database of five tertiary centers. Depression and anxiety risks were assessed by the Hospital Anxiety and Depression Scale (HADS); and quality of life assessed by Rheumatoid Arthritis Quality of Life (RAQoL), Nottingham Health Profile (NHP) and The Short Form 36 (SF 36) questionnaire. Results: Patients with higher risk for depression or anxiety had poorer quality of life compared to the patients without risk for depression or anxiety. Depression and anxiety scores significantly correlated with quality of life questionnaires. Th ere was significant association between anxiety and depression wit h worsening in both disease specific and generic health relat ed quality of life. However, RAQoL showed more association with depression and anxiety levels. Conclusion: Higher depression and anxiety risks showed increased deterioration in quality of life. Compared to generic QoL scales, RAQoL scale, a disease specific QoL instrument, is mu ch more influenced by depression and anxiety.

A new diagnostic scoring for discrimination of tuberculous and bacterial meningitis on the basis of clinical and laboratory findings.

Objectives: The aim of this study was to develop a new diagnostic index (DI) on the basis of clinical and laboratory findings including serum C-reactive protein (CRP) for tuberculous meningitis (TM) and bacterial meningitis (BM). Subjects and Methods: During a 7-year period, 96 adult patients with meningitis (30 with TM and 66 with BM) were studied retrospectively. Multivariate logistic regression analysis was performed to investigate the diagnostic value of clinical and laboratory parameters as independent predictors on discrimination of tuberculous from BM patients. Results: Six features predictive for diagnosis including age, CSF leukocyte count, PML dominance, length of illness, serum CRP level and blood WBC count were used. The DI model developed from these features had very high sensitivity and specificity rates of 100.0 and 95.4%, respectively. The sensitivity and specificity rates were 97.4 and 100%, respectively, in microbiologically proven cases. Conclusion: Our results suggested that this new DI which consists of simple clinical and laboratory parameters had the power to discriminate adult patients with documented tuberculous and BM (excluding Brucella meningitis). It should, however, be tested in prospective studies.