Alopecia Areata

Alopecia areata is an organ-specific autoimmune disease targeting hair follicles. It causes nonscarring hair loss. The prevalence rate of the disease is approximately 1 in 1000 people worldwide. The condition is most commonly seen as circular areas of hair loss, but it may sometimes be as extensive as to involve the whole scalp or whole body. The complex pathophysiology of alopecia areata involves an autoimmune basis. Association of alopecia areata with other autoimmune diseases, such as thyroiditis and vitiligo, and the good response of patients to immunosuppressive treatment support an autoimmune etiology. Although some poor prognostic signs are defined, the course of the disease is unpredictable and the response to treatment can be variable. To date, there are neither preventive nor curative measures to deal with the condition. First-line therapy for patchy disease is topical and intralesional steroids, whereas extensive disease is conventionally managed with immunotherapy. New treatment agents, such as excimer laser, low-dose recombinant interleukin 2, Janus kinase inhibitors, and simvastatin/ezetimibe, are promising

Acne Rosacea

Rosacea is a common chronic inflammatory cutaneous disorder with variable presentation and severity. Disease usually occurs between the ages of 30 and 50 years. Women are more commonly affected than men. Rosacea is divided into four subtypes: erythematotelangiectatic, papulopustular, phymatous, and ocular, and one variant: lupoid or granulomatous rosacea. Erythematotelangiectatic rosacea is manifested as flushing and persistent centrofacial erythema, and papulopustular rosacea as papules and pustules in a centrofacial distribution. With disease progression, phymas consisting of sebaceous gland hypertrophy can develop. Ocular rosacea can result in blepharitis and conjunctivitis. Diagnosis is made clinically. Management of rosacea consists of protective measures such as sun protection and gentle skin care and topical and systemic treatments to suppress inflammation and erythema

Foot problems and fitting of shoes in normal population

Ayak ağrıları ve diğer ayak sorunlarından çoğu zaman uygun olmayan ayakkabı giyimi sorumlu tutulmaktadır. Ayakkabı uygunluğu ile ayak sorunları arasındaki ilişkiyi araştırmak üzere planlanan bu çalışmada, ayak ağrısı dışındaki nedenlerle polikliniğimize başvuran 100 kişinin sağ ayakları ve ayakkabıları incelendi. Olguların 92'sinde ayakkabı genişliği ayak genişliğinden az, 3'ünde eşit, 5'inde fazla idi. Ayakkabısı geniş veya eşit olan 8 olgunun 3'ünde (%37,5) ayak-bacak ağrısı, 4'ünde (%50) ayakta deformite; dar olan 92 olgunun ise 50'sinde (%54,3) ayak-bacak ağrısı, 60'ında (%65,2) ayakta deformite saptandı. Ayakkabı uzunluğu bir olguda ayak uzunluğundan az, 2 olguda eşit, 97 olguda ise ayak uzunluğundan fazla idi. İstatistiksel değerlendirmelerde ayak-bacak ağrısı ile topuk yüksekliği arasında, metatarsalji ve bilek ağrısı ile ayakkabı-ayak genişlik farkı arasında, taban ağrısı ile ayakkabı pençe yüksekliği arasında istatistiksel anlamlı ilişki saptandı. Ayakkabı özellikleri ile ayakta deformite varlığı ve lokalizasyonu arasında ise istatistiksel anlamlı ilişki bulunamadı.Improper footwear is often supposed to be responsible for foot pain and other foot problems. In this study which was aimed to investigate the relationship between fitting of shoes and foot problems, shoes and right feet of a hundred patients without foot pain were examined. In 92 patients shoe width was smaller, in 3 patients it was equal and in 5 patients it was bigger than foot width. 3 of the 8 patients whose shoe width was bigger or equal to foot width (%37.5) had foot and leg pain, 4 of them (%50) had foot deformity; whereas 50 of the 92 patients whose shoe width was smaller than foot width (%54.3) had foot and leg pain, 60 of them (%65.2) had foot deformity. In 1 patient shoe length was smaller, in 2 patients it was equal and in 97patients it was bigger than foot length. Statistically significant relations were found between foot and leg pain and heel hight metatarsalgia and shoe-foot width difference ankle pain and shoe-foot width difference sole pain and sole hight of the shoe. There was not any statistically significant relationship between shoe specifications and deformity

The efficacy of behavioral modification program and pressure biofeedback method in children with encopresis who were resistant to standard treatment regimens

Amaç: Bu çalışmada enkoprezisli çocuklarda davranış düzenleme programına ek olarak uygulanan basınç biofeedback (BF) yönteminin anorektal fonksiyon ve kontinansın sağlanmasındaki etkinliğinin araştırılması amaçlandı. Gereç ve Yöntem: Sekiz çocuk (6 erkek ve 2 kız) çalışmaya dahil edildi. İlk 4 hafta tuvalet eğitimi, posadan zengin diyet ve koşullandırmadan oluşan standart davranış düzenleme programı uygulandı. Bu tedaviye dirençli çocuklara sonraki 4 haftada davranış düzenleme programına ek olarak haftada iki gün 60 dakika süreyle basınç BF uygulaması yapıldı. Anorektal fonksiyon ve yaşam kalitesi, BF tedavisinden önce, hemen sonra ve 1. ayda BF cihazı kullanılarak yapılan manometrik ölçümler, Wexner ve Holschneider inkontinans skorlama sistemleri, yaşam kalitesi ölçümü ve defekasyon günlükleri ile değerlendirildi. Bulgular: Anal manometrik ölçümlerde BF tedavisinden hemen sonra ve 1. ayda istirahat basıncında anlamlı azalma oldu (p<0,05). Maksimal sıkma basıncında artış eğilimi olmakla birlikte bu artış istatistiksel olarak anlamlı değildi. Ancak maksimal sıkma basıncının yarılanma süresinde ve algılama eşik volümünde anlamlı artış saptandı (p<0,005). Tedavi sonrasında ve 1. ayda yaşam kalitesi skorunda ve inkontinans şiddetinde de anlamlı düzelme saptandı (p<0,05). Sonuç: Çalışmamız standart tedavilere dirençli enkoprezisli çocuklarda davranış düzenleme programı ile beraber basınç BF uygulamasının anorektal fonksiyonları ve yaşam kalitesini anlamlı şekilde iyileştirebileceğini düşündürmektedir.Objective: The purpose of this study was to evaluate the efficacy of pressure biofeedback (BF) method as an adjunct to behavioral modification program on anorectal function and continence restoration in children with encopresis. Materials and Methods: Eight children (6 boys and 2 girls) were enrolled in the study. During the first four weeks, behavioral modification program including toilet training, fiber rich diet and conditioning was applied. During the following four weeks, pressure BF training as an adjunct to the behavioral modification program was applied for 60 minutes, two times a week to the children with persistent fecal incontinence. Anorectal function and quality of life were assessed with manometric measurements, Wexner and Holschneider incontinence scoring systems, quality of life measurement and defecation diaries before and immediately after the BF treatment and at 1st month. Results: Significant decrease in resting pressure was detected in manometric anal measurements immediately after the BF treatment and at 1st month (p&lt;0.05). Although a rising trend was observed in maximum squeeze pressure, it did not reach to a statistical significance. A decrease in sensory threshold and an increase in time for half of the maximal squeeze pressure were observed in the manometric pressure measurements (p&lt;0.005). A significant improvement in the quality of life and in the severity of incontinence was also found immediately after the BF treatment and at 1st month. Conclusion: Our study suggests that the application of pressure BF method as an adjunct to behavioral modification program may significantly improve anorectal functions and quality of life in children with encopresis who were resistant to standard treatment regimens

Lumbosacral list and spinal instability in low back pain patients

Skolyotik bireyler hariç tutularak yapılan bir değerlendirme ile lumbosakral listin, bel ağrılı bireylerde ağrısız kişilerden farklı olup olmadığının, ağrının süregenliğinden etkilenip etkilenmediğinin, radiküler ağrı ile ilişkili olup olmadığının, lomber omurganın sagittal plandaki instabilitesinden etkilenip etkilenmediğinin ortaya konması ve iki ayrı ölçüm yöntemi arasında fark olup olmadığının araştırılması amaçlandı. 45 akut, 43 kronik bel ağrılı hasta ile 41 bel ağrısız kontroldü lomber omurganın ayakta ön-arka ve lateral radyogramları kullanılarak yapılan değerlendirmede üç grup arasında lumbosakral list ve spinal instabilite yönünden fark saptanmadı (p>0.05). Radiküler ağrısı olan ve olmayan bel ağrılılar ve spinal instabilite saptanan ve saptanmayan kişiler arasında da lumbosakral list yönünden istatistiksel anlamlı fark izlenmedi (p>0.05). Ayrıca lumbosakral listin iki farklı ölçüm yöntemi arasında da anlamlı fark bulunamadı (p>0.05). Gerek lumbosakral list gerekse spinal instabilitenin bel ağrısı ve özellikleri yönünden belirleyici olmadığı sonucuna varıldı.In this study, excluding individuals who had scoliosis, we have assessed lumbosacral list to investigate if there is any difference between patients with low back pain and individuals without low back pain, if it is affected by the lumbar spinal instability and the duration of the pain, and if it is related to radicular pain. We have also compared two different measurement methods to estimate the lumbosacral list. Antero-posterior and lateral radiographs were taken in the standing position in 45 acute, 43 chronic low back pain patient and 41 volunteers without low back pain. There was not significant difference among 3 groups for lumbosacral list and spinal instability (p&gt;0.05). In terms of lumbosacral list; there was not any statistically significant difference between patients with and without radicular pain, and between individuals with and without spinal instability (p&gt;0.05). We have not found significant difference between the measurement methods of lumbosacral list either (p&gt;0.05). We may conclude that, in terms of low back pain both lumbosacral list and spinal instability have no predictive value

Comparison of the efficacy of etodolac and nimesulide in patients with acute sciatica

Bu çalışmada, selektif COX2 inhibitörü olduğu belirtilen nimesulid ve etodolakın akut siyataljili hastalardaki etkinlik ve tolerabilitesini araştırmak ve karşılaştırmak amaçlanmıştır. Rastgele seçilen 14 hastaya günde 3 defa 300 mg Etodolak tablet, diğer 14 hastaya ise günde iki defa 100 mg Nimesulid tablet 3 hafta boyunca verildi. Hastalar ilk başvurularında, 1. hafta ve 3. hafta sonunda sabah ağrısı, günboyu ağrı, gece ağrısı, valsalva ile ağrı, radiküler ağrı, bel hareketlerinde ağrı, el yer mesafesi (EYM) ve düz bacak kaldırma testi (DBKT) yönünden değerlendirildi. İlaçlara bağlı olduğu düşünülen yan etkiler kaydedildi. Etodolak grubunda başlangıca göre 1. haftada tüm, 3. haftada DBKT hariç diğer parametrelerde istatistiksel olarak anlamlı düzelme saptandı (p0.05). Her iki grupta birer hastada hafif gastrointestinal yakınmalar dışında yan etkiye rastlanmadı. Sonuç olarak, COX2'yi selektif olarak inhibe ettiği bildirilen bu iki NSAİİ'ın siyataljili hastalarda etkinlik ve tolerabilite açısından uygun bir seçim olduğu ve birbirine üstünlüğü olmadığı kanaatine varıldı.Etodolac and nimesulide are nonsteroidal antiinflammatory drugs, which are known as selective COX2 inhibitors. This study was designed to compare the efficacy and tolerability of nimesulide and etodolac in the treatment of acute sciatica. Twenty eight patients were assigned randomly into two groups for three weeks therapy: etodolac 300 mg, tid and nimesulide 200 mg, bid. Pain scores, straight leg raising test and finger to floor distance were evaluated at the beginning of the treatment and at the end of the first and third week. Significant improvements in all efficacy parameters were observed for each treatment at the end of the first and third week, except straight leg raising test at the end of third week in the etodalac group (p&lt;0.05). There were not significant differences in the therapeutic response between the two groups for any efficacy parameters (p&gt;0.05). There was not any important adverse effect except minimal gastrointestinal complaints in only one patient from each group. The results of the study show that, both drugs are effective and well tolerated in the treatment of patients with acute sciatica

Hip fractures in elderly and problems during rehabilitation

Kalça kırıkları disabilitenin önemli bir nedeni olarak yaşlı populasyonda sık görülen bir sorundur. Osteoporoz, Parkinson hastalığı ya da inme gibi nöromotor disfonksiyona neden olan hastalıklar, kognitif bozukluklar ve denge bozuklukları nedeniyle yaşlılar kalça kırıkları açısından genç populasyona göre daha yüksek risk altındadırlar. Bu hastalarda kırık öncesi fonksiyonel düzeye dönüş en iyi şekilde cerrahi tedavi ile mümkün olmaktadır. Ancak ileri yaş ve eşlik eden hastalıklar nedeniyle cerrahi sonrası komplikasyonlar daha fazla görülmekte ve buna bağlı olarak da mortalite hızı artmaktadır. Hayatta kalanlarda ise yaşam kalitesi belirgin şekilde olumsuz yönde etkilenebilmektedir. Bu yazıda amacımız yaşlı hastaların kalça kırıklarından korunması için alınması gereken önlemlerin yanı sıra, kalça kırıklı yaşlı bireylerin rehabilitasyonu ve rehabilitasyon aşamalarında karşılaşılabilecekleri sorunları gözden geçirmektir.Hip fractures, one of the main reasons for disability, are frequently seen in older population. Several diseases including osteoporosis, neuromotor dysfunctions such as a stroke or Parkinson's disease, cognitive and balance disorders put the elderly to a higher risk for hip fracture compared to the younger population. In this group of patients, surgery is best treatment modality in order to obtain a satisfactory functional status. However, in these patients, age and coexisting medical illness may cause an increase in complications resulting in higher mortality after the surgical interventions. Moreover, the quality of life may be adversely affected in survivors after the surgery. In this manuscript, the rehabilitation of the elderly patients suffering from hip fracture and the potential problems during the rehabilitation program has been reviewed besides the preventive care methods

Depression and anxiety in patients with fibromyalgia syndrome

Yapılan pek çok çalışmada, Fibromiyalji Sendromunun (FMS) patogenezinde psikiyatrik bozuklukların da rolü olabileceği gösterilmiştir. Biz de çalışmamızda FMS'lu hastalarda depresyon ve anksiyete düzeylerinin sağlıklı kontroller ve majör depresyonlu hastalardan farklılık gösterip göstermediğini, FMS'lu hastalarda özellikle hangi depresyon ve anksiyete bulgularının ayırt edici olduğunu ve depresyon ve anksiyete skorları ile klinik özellikler arasındaki ilişkiyi araştırmayı amaçladık. Çalışmaya yaş ve eğitim düzeyleri benzer olan 34 fibromiyalji sendromlu ve 21 majör depresyonlu hasta ile 14 sağlıklı kontrol alındı. Fibromiyalji grubunda Beck Depresyon Envanteri (BDE), Hamilton Depresyon Derecelendirme Ölçeği (HDDÖ), Durumluk Kaygı Ölçeği (DKÖ) skorları majör depresyon grubundan düşük, kontrol grubundan ise yüksek bulundu ve bu farklar istatistiksel olarak anlamlıydı (p0.05). Bu çalışma göstermiştir ki, FMS'lu hastalarda depresyon ve anksiyete düzeyleri kontrollerden daha yüksektir, ancak majör depresyon düzeylerine ulaşmamaktadır ve sinirlilik sendromun ayırt edici ruhsal belirtisidir. Sonuç olarak psikiyatrik bozukluklar ve FMS sendromu arasında bir ilişki olduğu ve FMS patogenezinde psikiyatrik bozuklukların rolü olabileceği kanaatine varıldı.Several observations showed that psychiatric disorders may be involved in the pathogenesis of Fibromiyalgia Syndrome (FMS). In this study we aimed to compare the depression and anxiety levels among FMS, major depression and healthy controls and to investigate which depression and anxiety features are especially discriminating. We also investigated the relationship between clinical features and depression and anxiety. The study included 34 female patients with FMS, 21 patients with major depression and 14 educational status, age and sex matched healthy controls. Beck Depression Scale (BDS), Hamilton Depression Rating Scale (HDRS) and State Anxiety Inventory (SAI) were significantly lower than major depression, and were higher than healthy controls in FMS (p &lt;0.05), Results of discrimantanaly sis for SAI showed that nervousness was exactly, and patient discomfort was low level discriminating for FMS. Similarly, in analysis of HDRS and BDS, it was found that somatic anxiety and patient discomfort was low level discriminating for FMS. We found statistically significant correlation between BDS and HDRS scores and intensity of general pain, intensity of pain after physical activity, intensity of pain with palpation (p&lt;0.05). We also found positive significant correlation between HDRS scores and sleep disturbance scores (p&lt;0.05). But there was no correlation between SAI scores and clinical features (p&gt;0.05). Our study indicates that depression and anxiety levels are higher than healthy controls, but don't reach levels of major depression, and nervousness is the major discriminating psychiatric feature of FMS. We concluded that there was a relationship between psychiatric disorders and FMS and psychiatric disturbance may play role in the pathogenesis of FMS

The Effect of Bisphosphonate Treatment on Blood Lipid Parameters in Patients with Postmenopausal Osteoporosis

Bisphosphonates are currently the most preferred class of drugs used for the treatment of metabolic bone disease such as osteoporosis and Paget’s disease. Although their exact mechanism has not been identified, the compounds containing amino group (amino bisphosphonates) were shown to decrease osteoclast activation by inhibiting mevalonate pathway. Because mevalonate pathway is essential in production of cholesterol, these compounds could also interfere with cholesterol synthesis. In the present study, the effects of aminobisphosphonates on lipid parameters in subjects who were diagnosed as osteoporosis were investigated. For this reason, 50 postmenopausal osteoporotic subjects were included in the study and 25 of them (mean age:54±9 years) received alendronate sodium (70mg/week) and the remaining 25 subjects (mean age:55±8 years) were given risedronate sodium (35mg/week). Blood samples were analyzed at baseline and at the end of sixth months. Total cholesterol, high density cholesterol (HDL-chol), low density cholesterol (LDL-chol), triglyceride, apolipoprotein A (Apo-A), apolipoprotein B (Apo-B) and lipoprotein (a) (Lip a) were investigated as lipid parameters. Total alkaline phophatase (TAP), bone-specific alkaline phophatase (BAP), osteocalcine (OCL) and urine deoxyprydolin (DPD) levels were assessed as bone remodeling markers. After six month treatment period, while significant changes were observed in bone remodeling parameters (p0.05). Our results suggest that moderate-term oral aminobisfosphonate treatment has no significant effect on blood lipid parameters