LIMPRINT study - the Turkish experience

Background: Lymphedema and chronic oedema is a major healthcare problem in both developed and non-developed countries The LIMPRINT study is an international health service based study to determine the prevalence and functional impact in adult populations of member countries of the International Lymphoedema Framework (ILF). Methods: 1051 patients from 8 centers in Turkey were recruited using the LIMPRINT study protocol. Data were collected using the core and module tools which assess the demographic and clinical properties as well as disability and QoL. Results: Most of the Turkish patients were recruited from specialist lymphedema services and were found to be female, housewives and having secondary lymphedema due to cancer treatment. The duration of lymphedema was commonly less than 5 years and most of them had ISL Grade 2 lymphedema. Cellulitis, infection and wounds were uncommon. The majority of patients did not get any treatment or advice before. Most of the patients had impaired QoL and decreased functionality, but psychological support was neglected. Although most had social health security access to Lymphedema centres nevertheless access seemed difficult due to distance and cost. Conclusion: The study has shown the current status and characteristics of lymphedema patients, treatment conditions, the unmet need for the diagnosis and treatment as well as burden of the disease in both patients and families in Turkey. National health policies are needed for the prevention, diagnosis and treatment in Turkey that utilise this informative data

Insufficiency Fracture of the Superior and Inferior Pubic Rami in a Patient with Osteomalacia: Case Report

Insufficiency fractures are subtype of stres fractures which occur when normal or physiological stresses are placed on weakened bone. These fractures occur in a variety of conditions in which the mineral content or the elasticity of bone is abnormal. The most common cause of insufficieny fracture is postmenopausal osteoporosis. The other important causes are senile osteoporosis, pelvic irradiation, corticosteroid treatment and rheumatoid arthritis. They also occured in vitamin D deficieny/osteomalacia. The diagnosis of pelvic insufficiency fracture due to osteomalacia should be suspected in a postmenopausal women presenting with severe groin and buttock pain and weakness.We presented here the clinical and radiological findings of superior and inferior pubic ramus insufficiency fracture in a patient with osteomalacia. (Osteoporoz Dünyasından 2010;16:44-8

THE RELATIONSHIP BETWEEN RADIOLOGIC SEVERITY AND GRIP AND PINCH STRENGTH IN HAND OSTEOARTHRITIS

AMAÇ: Çalışmamızın amacı, farklı el eklemlerindeki el osteoartritinin (EOA) radyolojik evresi ile el kavrama gücü ve parmak ucu kavrama güçlerinin ilişkisini değerlendirmektir. GEREÇ VE YÖNTEM: Çalışmaya 46-85 yaş arası, 55 (17 erkek, 38 kadın) EOA hastası ve 45-86 yaş arası 49 (31 kadın, 18 erkek) EOA olmayan sağlıklı kontrol dahil edildi. Hastaların el grafileri Kellgren Lawrence (KL) skalasına gore skorlandı. El kavrama ve parmak ucu kavrama gücü Jamar dinamometre ve pincmetre kullanılarak ölçüldü. Görsel analog skala (GAS) , ağrı değerlendirmek için kullanıldı. Elin değerlendirilmesi her iki elde Heberden ve Bouchard nodüllerinin palpasyonu ve birinci karpometakarpal (KMK) eklemde krepitasyon aranması ile yapıldı. BULGULAR: Ağrının ciddiyetinin değerlendirildiği GAS düzeyi hasta grubunda kontrol grubuna gore belirgin olarak yüksekti (p0,05). El kavrama (r=-0,253, p0,05). SONUÇ: Bu bulgular EOA hastalarının hastalıktan önceki kavrama güçlerinin daha iyi olup bu artmış kas gücünün EOA gelişimine yatkınlığa neden olabileceğini düşündürmektedir.OBJECTIVE: The aim of this study is to investigate the relationship between pinch and grip strength and the radiologic severity of hand osteoarthritis (HOA) in different hand joints. MATERIAL AND METHODS: Fifty-five patients (17 male, 38 female) with HOA between ages 46-85 and 49 control subjects (31 female, 18 male) without HOA between ages 45-86 were included in the study. Hand radiograph of the patients were scored according to Kellgren Lawrence (KL) scale. Grip and pinch strength of hands was measured using a Jamar dynamometer and a pinchmeter. Visual analogue scale (0-10 scale) was used for pain intensity. Examination of hand consisted of palpation of Heberden and Bouchard knodes and crepitation of first carpometacarpal (CMC) joints in both hands. RESULTS: Severity of pain by VAS was significantly higher in the patient group than in the controls (p0,05). There were negative but weak correlations between grip strength (r=-0,253, p0,05).CONCLUSION: These results may suggest that the HOA group had higher prior pinch and grip strength values and this higher muscle strenght may be responsible for the development of HOA

Postmenopozal Romatoid Artritli Hastalarda Bifosfonat Tedavisinin Hastalik Aktivitesi Üzerine Etkisi

INTRODUCTION: Bisphosphonates therapy may be potentialadjunctive therapy agents of synthetic disease modifying antirheumaticdrugs in rheumatoid arthitis patients who have contraindications andwho are intolerant to biologics. The aim of this retrospective study wasto evaluate the effects of adjunctive Bisphosphonates on disease activityof our patients with rheumatoid arthitis who underwent the syntheticdisease modifying antirheumatic drugs therapy.MATERIAL AND METHOD: Retrospective data were collectedfrom patient records of our Rheumatology department outpatientclinic. Files of 207 patients who are over 45 years old and whose bonemineral density were evaluated in the previous year were screened forthe study. Patients demographics, medications, disease duration, theage of disease onset, anti-Cyclic Citrullinated Peptid, Rheumatoid factorpositivily, Disease activity scores positivity were recorded. Bone mineraldensitometry analyses were performed in patients by Dual EnergyX-ray Absorptiometry. 106 patients (89 women, 17 men) who receivedbisphosponates therapy for 1 year constituted group1 and 101 patients (81women 20 men) who did not receive bisphosponates constituted group 2.RESULTS: The mean age of group 1 was 65.02 11.14 years and group2 was 63.649.1 years (p 0.05). There was no statistically significantdifference between groups in terms of age, gender and disease durationparameters. There were no statistically significant difference according todisease modifying antirheumatic drugs type and dosages between groups(p 0.05) but in group 1, prednisolone users were more than group 2(p 0.001). The mean tender joint count changes were -0.640.63 ingroup 1 and 0.420.62 in group 2 (p0.001). There were no significantdifference according to bone mass density values of prednisolone usersand nonusers at baseline and after 1 year.DISCUSSION: For patients who cannot be treated with biological agents,effective prevention of focal bone damage and generalized bone losswill require new treatment strategies, like concomitant administrationof drugs with specific effects on bone metabolism. Bisphosponates canprevent generalized bone loss and therapies may yield both medical andeconomic benefits in patients with rheumatoid arthritis.CONCLUSION :We think that adjunctive bisphosponates may provideadditional benefits in older rheumatoid arthritis patients with systemicand regional bone loss. However, further studies are needed to determinewhether bisphosphonate therapies must be administered routinely with thedisease modifying antirheumatic drugs and biologics.GİRİŞ: Bifosfonat tedavileri, biyolojik ajanlara intoleransı veyakontreendike durumu olan romatoid artrit hastaları için sentetikhastalık modifiye edici ajanların etkisini tamamlayan ajanlar olabilir. Buretrospektif çalışmanın amacı bifosfonat tedavisinin sentetik modifiyeedici ajan kullanan romatoid artrit hastalarındaki hastalık aktivitesiüzerine etkisini incelemektir.MATERYAL VE METHOD: Veriler kliniğimizin romatolojidepartmanındaki hasta kayıtlarının retrospektif olarak incelenmesiile elde edilmiştir. Çalışma için, 45 yaş üstü ve ardışık yıllarda kemikmineral yoğunluğu değerlendirilen 207 hasta dosyası tarandı. Hastalarındemografik bilgileri, ilaçları, hastalık süreleri, hastalığa yakalandıklarıyaş, anti-siklik sitrullin peptit, romatoid faktör pozitifliği, hastalık aktiviteskorları gibi bilgiler kayıt edildi. Kemik mineral dansitesi analizleri dualenerji x-ray absorptiometri ile yapıldı. Bir yıldır bifosfonat tedavisi alan106 hasta (89 kadın, 17 erkek) grup1, bifosfonat tedavisi almayan 101hasta (81 kadın, 20 erkek) ise grup 2 olarak ayrıldı.BULGULAR: Grup 1 hastaların yaş ortalaması 65.02 11.14 yıliken, grup 2 hastalarınki 63.649.1 yıl idi (p0.05). Gruplar arasındayaş, cinsiyet, hastalık süresi açısından istatistiksel olarak anlamlı farkyoktu. Gruplar arasında kullanılan hastalık modifiye edici ilaç tipleri vedozajları arasında istatistiksel olarak anlamlı fark yoktu (p0.05), fakatgrup 1'de prednizolon kullanımı grup 2'den daha fazlaydı (p0.001).Ortalama hassas nokta sayısındaki değişimler grup 1'de -0.640.63,grup 2 ise 0.420.62 idi (p0,001). Bir yıl sonunda prednizolon kullananve kullanmayan hastalar arasında kemik mineral dansitesi değerleriaçısından istatistiksel olarak anlamlı fark yoktu.TARTIŞMA: Biyolojik ajanlarla tedavi edilemeyen hastalar için, fokalkemik hasarının ve genel kemik kaybının etkili bir şekilde önlenmesi,kemik metabolizması üzerinde belirli etkilere sahip ilaçların eşzamanlıuygulanması gibi yeni tedavi stratejileri gerekmektedir. Bisfosfonatlar,jeneralize kemik kaybını önleyebilir ve romatoid artritli hastalarda hemtıbbi hem de ekonomik yararlar sağlayabilir.SONUÇ: Bifosfonatların, sistemik ve bölgesel kemik kaybı olandaha yaşlı romatoid artritli hastalarda ek yararlar sağlayabileceğinidüşünüyoruz. Bununla birlikte, bifosfonat tedavilerinin, rutin olarakantiromatizmal ilaçlar ve biyolojik maddeleri modifiye eden hastalıklarlabirlikte uygulanmasının gerekip gerekmediğini belirlemek için daha ileriçalışmalara ihtiyaç vardır

The Association of Skinfold Anthropometric Measures, Body Composition and Disease Severity in Obese and Non-obese Fibromyalgia Patients: A Cross-sectional Study

Objectives: This study aims to determine the effects of obesity and obesity related anthropometric and body composition determiners on the severity of fibromyalgia syndrome (FS) and to compare obese, overweight and normoweight FS patients according to general health and psychological status. Patients and methods: The study included 42 obese (mean age 48.8±11.6; range 24 to 65 years), 27 overweight (mean age 47.3±3.4; range 24 to 61 years) and 32 normoweight (mean age 47.1±7.8 years; range 31 to 60 years) female FS patients. Widespread pain scores and symptom severity scores were noted. Pain pressure thresholds of tender points and control points were measured and total myalgic score (TMS) was calculated. The anthropometric assessments and skinfold measurements of all participants were recorded. Quality of life was evaluated by Health Assessment Questionnaire while psychological status was evaluated using Beck Depression Inventory. Results: Control points, TMS values and hand grip strength values of obese FS patients were significantly lower, while disease duration, symptom severity, widespread pain scores, visual analog scale and Health Assessment Questionnaire scores were significantly higher than normoweight and overweight FS patients. Fat free mass, fat mass, body fat percentage and waist/hip ratio values were significantly higher in obese FS patients than overweight and normoweight FS patients (p<0.001 for all values). Stepwise linear regression analysis showed that increased body mass index, decreased fat free mass (R2=0.11) and increased disease duration (R2=0.13) were associated with lower TMS. Conclusion: We found that obesity had significant negative effects on pain, disease severity and quality of life in patients with FS

Pulmonary Rehabilitation Principles After SARS-CoV-2 (COVID-19): A Guideline for the Management of Acute and Subacute Course

Coronavirus disease 2019 (COVID-19) is a contagious infection disease, which may cause respiratory, physical, psycological and generalised systemic dysfunction. The severity of disease ranges from an asymptomatic infection, mild illness, mild or severe pneumonia with respiratory failure, acute respiratory distress syndrome and/or death. COVID-19 affects the pulmonary system crucially. There is a lack of knowledge about the longterm outcomes of the disease and the possible sequeles and rehabilitation, as well. This clinical practice guideline includes pulmonary rehabilitation (PR) recommendations for adult COVID-19 patients and is developed in the light of the guides on the diagnosis and treatment of COVID-19 provided by World Health Organisation and Turkish Republic Ministery of Health, and recently published scientific literature, PR recommendations for COVID-19 regarding basic principles of PR. In this guideline, the contagiousness of COVID-19, recommendations on limited contact of patient with health care providers, and the evidence about possible benefits of PR were taken into consideration.Coronavirus Hastalığı 2019 (COVID-19) solunumsal, fiziksel, psikolojik ve yaygın sistemik işlev bozukluğuna yol açabilen bulaşıcı bir hastalıktır. Hastalığın ciddiyeti asemptomatik enfeksiyondan, hafif hastalık, pnömoni, ciddi pnömoni, akut solunum sıkıntısı sendromu, solunum yetmezliği ve ölüme kadar değişebilmektedir. COVID-19 solunum sistemi önemli şekilde etkilenmektedir. Hastalığın uzun dönem sonuçları ve muhtemel sekellerine ilişkin yeterli bilgi olmadığı gibi, rehabilitasyonu konusunda da henüz kanıt yoktur. Bu klinik uygulama rehberi erişkin COVID-19 hastaları için pulmoner rehabilitasyon önerileri içermektedir ve Dünya Sağlık Örgütü ile T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü tarafından hazırlanan COVID-19 tanı ve tedavi rehberleri, yakın zamanlı bilimsel yayınlar, uzman görüşü olarak yayınlanan COVID-19 için pulmoner rehabilitasyon önerileri ışığında ve pulmoner rehabilitasyonun temel prensipleri doğrultusunda hazırlanmıştır Bu öneriler geliştirilirken, COVID-19’un bulaşıcılığı, sınırlı sayıda personelin hasta ile teması ilkeleri ile pulmoner rehabilitasyonun sağlayacağı yararların düzeyi göz önünde bulundurulmuştur

Pulmonary rehabilitation principles in SARS-COV-2 infection (COVID-19): A guideline for the acute and subacute rehabilitation

Coronavirus disease 2019 (COVID-19) is a contagious infection disease, which may cause respiratory, physical, psychological, and generalized systemic dysfunction. The severity of disease ranges from an asymptomatic infection or mild illness to mild or severe pneumonia with respiratory failure and/or death. COVID-19 dramatically affects the pulmonary system. There is a lack of knowledge about the long-term outcomes of the disease and the possible sequelae and rehabilitation. This clinical practice guideline includes pulmonary rehabilitation (PR) recommendations for adult COVID-19 patients and has been developed in the light of the guidelines on the diagnosis and treatment of COVID-19 provided by the World Health Organization and Republic of Turkey, Ministry of Health, recently published scientific literature, and PR recommendations for COVID-19 regarding basic principles of PR. In this guideline, the contagiousness of COVID-19, recommendations on limited contact of patient with healthcare providers, and the evidence about possible benefits of PR were taken into consideration