The Relationship of Lean Body Mass with Vitamin D Level and Physical Performance

Objective:In this study, it was aimed to investigate the association between vitamin D level, physical performance and lean body mass (LBM).Materials and Methods:A hundred female patients with 35-50 age range were included in the study. Patients’ demographic variables, height and weight measurements were recorded and body mass index (BMI) was calculated. Serum 25-hydroxyvitamin D (25(OH)D) samples were analyzed. Patients were divided into 2 groups according to 25(OH)D levels; patients with low vitamin D levels (group 1) and normal vitamin D levels (group 2). Both groups’ LBM was assessed by dual-energy X-ray absorptiometry and physical performance was assessed by 6-Minute Walk Test (6MWT).Results:Mean levels of 25(OH)D were found as 14.026±7.10 ng/mL in group 1 and 43.40±10.03 ng/mL in group 2. When the results of LBM were evaluated, the mean of group 1 was 35.48 (26.33-47.17) kg and the group 2 was 35.14 (29.23-53.65), and there was no statistically significant difference between the groups with regard to the mean of LBM (p=0.679). No statistically significant difference was determined in terms of 6-MWT (p=0.992). According to serum 25(OH)D level, group 1 was divided into three subgroups as follow; Group 1a: 25(OH)D<10 ng/dL, group 1b: 10.1≤ 25(OH)D≤ 20 ng/dL, and group 1c: 20.1≤25(OH)D≤29.9 ng/dL. When the three subgroups of group 1 (group 1a, 1b, and 1c) and group 2 compared, there was no statistically significant difference observed between the LBM and 6-MWT means (p=0.975; p=0.644).Conclusion:In this study, we could not determine a relationship between LBM and serum 25(OH)D level, and physical performance. In patients with same exclusion criteria, we believe that it is necessary the studies evaluating on the serum 25(OH)D levels along with genetic factors influencing the functions of vitamin D and also on the muscle quality along with muscle mass

Familial Mediterranean fever with recurrent erysipelas-like erythema and myalgia: A case report

Familial Mediterranean fever (FMF) is a disease progressing with recurrent serositis episodes and usually accompanied by fever. Symptoms, such as myalgia and skin lesion, are less common in the clinical presentation of FMF. Herein, we present a 23-year-old female patient who was admitted to our outpatient clinic with myalgia. She had no findings of typical episodes for FMF. However, on physical examination, she had an unrecognized skin lesion. In conclusion, FMF should be kept in mind in patients with recurrent erysipelas-like lesions

Influence of disease activity and chronicity on bone mineral density in ankylosing spondylitis

Bu çalışmada 37 ankilozan spondilitli hastada, hastalık aktivite ve süresi ile kemik mineral yoğunluğu (KMY) arasındaki ilişkinin araştırılması amaçlandı. Lomber vertebra, kalça ve ön kol’un KMY’u ölçmek için dualenerji x-ray absorbsiyometri tekniği kullanıldı. Hastalar hastalık süresi ve aktivitesine göre 2 gruba ayrıldı. Ölçülen tüm bölgelerdeki KMY değerlerinde aktif ve inaktif gruplar arasında fark yoktu. Lomber vertebra KMY değerlerinin erken evre grupta anlamlı düşük olduğu saptandı.In this study we aimed to examine the relationship between disease activity/duration and bone mineral density (BMD) on 37 patients with ankylosing sponylitis. Patients were classified according to disease activity and duration. We have used dual-energy x-ray absorptiometry (DEXA) to measure bone mineral density of lumbar spine, hip and forearm. A comparison of BMD between patients with active and inactive disease did not reveal a significant difference on all of the regions measured. Concerning disease duration, lumbar spine BMD was significantly reduced in early disease subject

Ailevi akdeniz ateşi ve ankilozan spondilit birlikteliği: Olgu sunumu

Ailevi Akdeniz Ateşi (AAA), etiyolojisi bilinmeyen otozomal resesif bir hastalıktır. AAA'de eklem tutulumunun nadir görülen bir formu genellikle HLAB27 negatif spondilartropatidir. Bu hastalarda sakroiliit ile birlikte inflamatuvar boyun ve bel ağrısı da gözlenir ve lumber ve servikal direk grafiler normal olabilir veya minimal değişiklik saptanabilir. Bu olgu sunumunda, klinik ve radyolojik bulgularına göre ankilozan spondilit (AS) tanısı koyduğumuz AAA'li bir hasta sunulmuştur.Familial Mediterranean fever (FMF) is an autosomal recessive disease of unknown origin. A less common manifestation of joint involvement in FMF is spondylartropathy, which is almost always HLA B27 negative. In these patients, along with sacroiliitis, inflammatory neck and back pain is also present producing minimal or no radiographic changes on plain films of lumbar and cervical spine. In this report, we presented a patient with FMF whom had been diagnosed to be ankylosing spondilitis (AS) in the light of some clinical and radiological findings

Kronik Bel Ağrısında Basınç Ağrı Eşiği ve Yaygın Ağrının Değerlendirilmesi

Amaç: Bu çalışmanın amacı, kronik bel ağrısı olan hastalar ve sağlıklı bireyler arasında basınç ağrı eşiği değerleri açısından farkı belirlemek, aynı zamanda kronik bel ağrısı olan hastalarda farklı anatomik bölgelerde basınç ağrı eşiği test edilerek yaygın ağrıyı incelemektir.Gereç ve Yöntemler: Kronik bel ağrılı 70 hasta ve 62 sağlıklı kontrol çalışmaya dahil edildi. Basınç ağrı eşiği, her iki grupta, Amerikan Romatizma Cemiyeti tarafından belirlenen 18 fibromiyalji hassas noktası, 12 siyatik valleks noktası ve 4 lomber paravertebral nokta olmak üzere toplam 34 noktada değerlendirildi. Basınç ağrı eşiği ölçümleri, yüzey alanı 1 cm2 olan elektronik basınç algometre cihazı ile yapıldı. Bulgular: Kronik bel ağrılı hastalarda tüm noktalarda ortalama basınç ağrı eşiği, sağlıklı kontrollere göre anlamlı düzeyde düşük bulundu (p=0,001). Sonuç: Bu çalışma, kronik bel ağrılı hastalarda sağlıklı kontrollere göre tüm vücutta basınç ağrı eşiğinin düşük olduğunu gösterdi. Bu sonuç, kronik bel ağrısı olan hastaların değerlendirilmesinde yaygın ağrının göz önünde bulundurulması gerektiğini düşündürür niteliktedir.Objective: The purpose of this study was to determine differences in pain pressure threshold (PPT) values between patients with chronic low back pain (CLPB) and healthy people and to also evaluate widespread pain sensitivity by testing PPT in different sites of patients with CLBP.Material and Methods: Seventy subjects with CLBP and 62 healthy controls were included in the study. PPT values were evaluated for a total of 34 points, including 18 tender points defined for fibromyalgia syndrome by the American College of Rheumatology, 12 points for testing of sciatic valleix, and 4 lumbar paravertebral points, in both groups. An electronic pressure algometer was used to measure PPT with a stimulation surface area of 1 cm2. Results: A significantly lower mean PPT was determined for all test sites in the patients with CLBP compared with healthy controls (p=0.001).Conclusion: The study showed that patients with CLBP have significantly lower PPT values at every individual site compared with healthy controls. This result suggests that widespread pain should be taken into account in the evaluation of patients with CLBP

Ailesel Akdeniz ateşinde spondilit ve artrit

Amaç: Bu çalışmada ailesel Akdeniz ateşi (AAA) tanısı olan ve artrit/spondilit bulgusu ile takip edilen hastaların klinik özellikleri incelendi. Hastalar ve yöntemler: Kasım 2000 - Mart 2012 tarihleri arasında artrit veya inflamatuvar omurga ağrısı yakınması ile başvuran ve AAA tanısı konmuş 29 hastanın (12 erkek, 17 kadın; ort. yaş 26.1±11.2 yıl; dağılım 16-51 yıl) verileri retrospektif olarak incelendi. Hastaların yaş ve cinsiyetleri kaydedildi. Artrit/spondilit başlangıç yaşı, AAA tanı yaşı, ailede AAA öyküsü ve geçirilmiş cerrahi girişim öyküsü varlığının yanı sıra, periferik artriti bulunan hastaların tutulan eklem sayısı ve yeri de kaydedildi. Sakroiliit ve spondiliti bulunan hastalarda periferik artrit varlığı incelendi ve tedavide kullanılan ilaçlar kaydedildi. İnsan lökosit antijen (HLA)-B27 ve Akdeniz ateşi (MEFV) geni analizi yapılmış hastaların sonuçları kaydedildi. Bulgular: Artrit/spondilit başlangıç yaşı ortalama 20.4±9.1 yıl idi. Hastaların 24'ünde artrit (15'inde monoartrit, 9'unda oligoartrit) mevcuttu ve en sık etkilenen periferik eklem, ayak bileği idi (n=13). Beş hastada artritle birlikte spondilit, diğer beş hastada sadece spondilit mevcuttu. Dört hastada total kalça replasmanı, bir hastada diz debridmanı ve bir hastada apendektomi öyküsü vardı. Akdeniz ateşi geni analizi yapılan 27 hastanın 10'unda M694V homozigot mutasyonu (%37) saptandı ve total kalça replasmanı cerrahisi geçiren hastaların tümünde aynı mutasyon vardı. HLA-B27 gen incelemesi yapılan 21 hastanın ikisinde HLAB27 pozitif idi. Sonuç: Ailesel Akdeniz ateşi genç hastalarda inflamatuvar artrit ve spondilit ayırıcı tanısında mutlaka yer almalıdır. Klasik artrit atakları en sık görülen klinik tablo olsa da kronik eroziv eklem tutulumu ve spondilitin de bu hastalığın bir klinik görünümü olduğu akılda tutulmalıdır. Kolşisin tedavisi atakların ve amiloidozun önlenmesinde etkili olmakla birlikte, kronik eroziv artritlerde olduğu gibi romatolojik hastalıkların ağır formlarında kullanılan hastalık modifiye edici antiromatizmal ilaçlar (DMARD) ve biyolojik ilaçlar da etkin tedavi seçenekleri olarak görülmektedir.Objectives: This study aims to evaluate the clinical features of patients who are diagnosed with familial Mediterranean fever (FMF) and followed due to arthritis/spondylitis findings. Patients and methods: The data of 29 patients (12 males, 17 females; mean age 26.1±11.2 years; range 16 to 51 years) who presented with arthritis and/or inflammatory spinal pain and were diagnosed with FMF between November 2000 and March 2012 were retrospectively analyzed. The age and gender of the patients were recorded. The age of onset of arthritis/spondylitis, age at FMF diagnosis, family history of FMF, and previous surgical history as well as the number of affected joints and their localization were also recorded. The presence of peripheral arthritis in patients with sacroiliitis and spondylitis was also investigated, and the drugs used for treatment were recorded. The results were documented in patients who underwent human leukocyte antigen (HLA)-B27 and Mediterranean fever (MEFV) gene analysis. Results: The mean age of onset of arthritis/spondylitis was 20.4±9.1 years. Arthritis was observed in 24 of the patients (monoathritis in 15 patients, oligoarthritis in 9 patients), and the most affected peripheral joint was the ankle (n=13). Five patients had both arthritis and spondylitis while five others had only spondylitis. Four patients had a history of total hip replacement, one with knee debridement, and one with an appendectomy. The Mediterranean fever gene analysis was performed on 27 patients, and 10 of them (37%) had a M694V homozygous mutation, and those who had undergone total hip replacement had the same mutation. The HLA-B27 gene analysis was performed on 21 patients, and two of them tested positive. Conclusion: Familial Mediterranean fever should be included in the differential diagnosis of inflammatory arthritis and spondylitis in young patients. Classical arthritis attacks are the most common clinical presentation; however, chronic erosive joint involvement and spondylitis should be also recognized as clinical features of the disease. Although colchicine therapy is effective in preventing attacks and amyloidosis, both disease-modifying antirheumatic drugs (DMARDs) and biological drugs appear to be effective in treating severe forms of rheumatological disorders and chronic erosive arthritis. Top Abstract Introduction Methods Results Disscussion Reference

Clenched Fist Syndrome; an Isolated Fixed Dystonia: A Case Report and Review of the Literature

Scientific BACKGROUND: Fixed dystonia, is an immobile dystonic posture which could not return to neutral position at rest. Clenched fist syndrome, which is an isolated form of fixed dystonia of hands, could be confused with focal hand dystonia. Fixed dystonias could be seen in symptomatic dystonias (such as corticobasal degeneration, acquired basal ganglion disease), complex regional pain syndrome, and psychological movement disorder. The diagnosis of this kind of dystonias may be delayed and the treatment is difficult. OBJECTIVE: Our aim is to present a case with clenched fist syndrome, to discuss the differential diagnosis, treatment and to review of the literature. CASE: The patient is a 42-year-old woman with inability to use her right hand for 5 and left hand for 3 years. In physical examination, dorsum of the hands were oedematous, palms of the hands were macerated with a bad odour, and unguis had a dystrophic appearence. In neurologic examination, clenched fists were observed. Voluntary and forced extension of the interphalangeal and metacarpophalangeal joints were impossible. After general anesthesia, passive extension of the hands were only minimal. Cranial, spinal magnetic resonance imaging and blood chemistry were within normal limits. In needle electromyographic study dystonic discharges were not observed. Multidisciplinary approach was performed in management. CONCLUSION: In clenched fist syndrome or generally in fixed dystonias, invasive treatment modalities had to be avoided. Treatment modalities including physiotherapy, work-therapy, behavioural therapy, psychotherapy, botilinum toxin injection, medical treatment such as anticholinergics, benzodiazepine and antiepileptics should be performed by multidisciplinary approach after primary and secondary etiologies were eliminated. This means neurologist, physiotherapist, psychiatrist, dermatologist, and hand surgeon should work together when dealing such a patien

Ulnar and radial nerve ınjury due to acute compartment syndrome

Kompartman sendromu, ekstremitelerde kapalı kas fasyalarının içinde artmış perfüzyon basıncı nedeni ile meydana gelen iskemi sonucu, kas ve sinir dokularında fonksiyon kaybı ile karakterize klinik bir tablodur. Üst ekstremitede kompartman sendromuna yol açan bir çok neden vardır. Bu nedenler arasında, kemik kırıkları, kas ve yumuşak dokuda oluşan ezilme yaralanmaları, uzun süreli kompresyon, kasların avulsiyonu, yanık, böcek ısırıkları, aşırı egzersiz, enfeksiyon, kanama, intravenöz ilaç enjeksiyonu sayılabilir. Bu yazıda, vasküler, kas ve median sinir kesisi nedeniyle opere edilen hastada kompartman sendromu sonucu gelişen radial ve ulnar sinir hasarı sunulmaktadır.Compartment syndrome is characterized by loos of function of nerve and muscle due to ischemia, after increased perfusion within a closed fascial space. Many conditions lead to upper extremity compartment syndromes. The causes are bone fracture, crush injury in the muscle and soft tissues, prolonged limb compression, muscle avulsion, burns, insect bites, excessive exercise, infections, hemorrhage, and intravenous drug injections. In this case report we presented ulnar and radial nerve injury as a consequence of the compartment syndrome in a patient who was operated on for vascular and muscle and median nerve injuries

Effect of traction therapy in knee osteoarthritis: A prospective controlled study

Amaç: Diz osteoartriti tedavisinde traksiyon tedavisinin etkinliğini araştırmak. Hastalar ve Yöntem: Diz osteoartriti tanısı almış 43 hasta çalışmaya dahil edildi. Hastaların ayakta basarak ön-arka diz grafileri çekildi ve Kellgren- Lawrence sınıflaması yapıldı. Yirmi dört hasta traksiyon, hot pack, mikrodalga ve kuadriseps izometrik egzersizleri ile, 19 kontrol hastası hot pack, mikrodalga ve kuadriseps izometrik egzersizleri ile 15 seans tedavi edildi. Traksiyon tedavisi, hastalar masa üzerinde oturur pozisyonda, diz tam ekstansiyonda 20 dakika süre ile 15 kg ağırlık uygulanarak intermittant olarak yapıldı. Tüm hastaların tedavi öncesi ve sonrası diz eklem hareket açıklığı goniometrik olarak ölçüldü. Diz ağrısı vizüel analog skala (VAS) (hareket ve istirahatte) ile, fonksiyonel durum Lequesne Fonksiyonel İndeksi ile değerlendirildi. Tüm değerlendirmeler tedavi başlangıcında ve tedavi bitiminde yapıldı. Bulgular: Traksiyon grubunda tedavi öncesi ve sonrası VAS (hareket sırasında) (p<0.05), VAS (istirahat sırasında) (p<0.05) ve Lequesne Fonksiyonel indeksi (p<0.05) parametrelerinde kontrol grubuna göre istatistiksel olarak anlamlı bir azalma saptandı. Sonuç: Diz osteoartritinde traksiyon tedavisinin ağrı ve fonksiyonel durum üzerinde yararlı etkisi olduğunu düşünmekteyiz.Objective: To investigate the effect of traction therapy on knee osteoarthritis. Patients and Methods: Forty-three patients diagnosed knee osteoarthritis were included in this study. Knee radiographies of patients were taken and classified according to Kellgren-Lawrence classification. Twenty-four patients were treated with traction, hot pack, microwave and isometric exercises while 19 patients in control group were treated with hot pack, microwave and isometric exercises for 15 sessions. Traction was applied intermittently with 15 kg for 20 minutes while patients were sitting position, their legs fully extended. Range of motion of knee was measured with goniometry. The patient's functional status was determined with Lequesne Functional Index and pain levels in rest and motion evaluated with visual analog scale (VAS) before and after 15 therapy sessions. Results: There was statistically significant decreasing in VAS (rest) (p<0.05), VAS( motion) (p<0.05) and Lequesne Funtional Index (p<0.05) in traction group. Conclusion: We suggest traction therapy has beneficial effects on pain and functional status in knee osteoartrhritis