Türk hekimlerinin fibromiyalji tedavisindeki tutumları; pregabalinofobi ağrı tedavisinin yeni gerçeği mi?

OBJECTIVES: This study aims to determine the treatment preferences of physicians interested in fibromyalgia treatment and to investigate their hesitations about prescribing pregabalin. METHODS: Our survey study was conducted between February 5 and 20, 2021. The survey forms were sent to the known email addresses and phone numbers of 1569 physical medicine and rehabilitation (PMR), algology, and rheumatology physicians. The replies to the surveys were checked for possible resubmissions. The pooled data were evaluated with the SPSS 22.0 statistical package program. Frequency distributions were calculated and presented as n, %. RESULTS: Four hundred and six PMR, rheumatology, and algology specialists fulfilled the study forms. About 59.0% of physicians stated that they prefer duloxetine as the first-line agent of fibromyalgia syndrome (FMS) treatment. Pregabalin was only 6.0% of the physicians' first choice for FMS. About 35.0% of the participating physicians stated that the PMR department should follow up FMS patients. About 44.3% of the participants noted that they refer FMS patients to other departments which interested in FMS treatment and do not want to follow-up FMS patients. About 81% agreed that pregabalin causes addiction. About 36.7% stated that at least 20% of the patients could abuse pregabalin and 97.8% of physicians stated that they were prejudiced about prescribing pregabalin to prisoners. Approximately two of the three physicians experienced an act of violence in their hospital regarding pregabalin prescribing. CONCLUSION: These data showed that the 'Pregabalinophobia' should be accepted. This condition is associated with life safety concerns of the physician not only from unreliability of the drug. It seems that the doctors have valid reasons to develop this prejudice.Amaç: Bu çalışma, fibromiyalji tedavisi ile ilgilenen hekimlerin tedavi tercihlerini belirlemek ve pregabalin reçetelemek konusundaki tereddütlerini araştırmayı amaçlamaktadır. Gereç ve Yöntem: Anket çalışmamız 5 Şubat 2021–20 Şubat 2021 tarihleri arasında gerçekleştirildi. Fiziksel tıp ve rehabilitasyon, algoloji ve romatoloji hekimlerinden oluşan 1569 kişinin bilinen e-posta adreslerine ve telefon numaralarına anket formları gönderildi. Anketlere verilen yanıtlar olası yeniden gönderimler açısından kontrol edildi. Veri havuzu SPSS 22.0 istatistik paket programı ile değerlendirildi. Frekans dağılımları hesaplandı ve n, % olarak sunuldu. Bulgular: Dört yüz altı fiziksel tıp ve rehabilitasyon, romatoloji ve algoloji uzmanı çalışma formlarını tamamladı. Hekimlerin %59’u fibromiyalji tedavisinde birinci basamak ajan olarak duloksetin tercih ettiklerini belirtti. Pregabalin, hekimlerin fibromi-yalji için ilk tercihinin sadece %6'sıydı. Çalışmaya katılan hekimlerin %35'i fibromiyalji hastalarının fiziksel tıp ve rehabilitasyon bölümlerinde takip edilmesi gerektiğini belirtti. Katılımcıların %44,3’ü fibromiyalji hastalarını, fibromiyalji tedavisi ile ilgilenen ve fibromiyalji hastalarını takip etmek isteyen diğer bölümlere sevk ettiklerini belirtti. Katılımcıların %81'i pregabalinin bağımlılığa neden olduğunu kabul etti. Katılımcıların %36,7'si fibromiyalji hastalarının en az %20'sinin pregabalini kötüye kullanabileceğini belirtti. Hekimlerin %97,8'i mahkumlara pregabalin reçete edilmesi konusunda ön yargılı olduğunu belirtti. Üç hekimden yaklaşık ikisi hastanelerinde pregabalin reçete edilmesi ile ilgili bir şiddet olayına maruz kaldığını belirtti. Sonuç: Bu veriler “pregabalinofobi”nin kabul edilmesi gerektiğini göstermektedir. Bu durum, yalnızca ilacın güvenilmezliğinden değil, hekimin can güvenliği endişeleriyle de ilişkilidir. Görünüşe göre doktorlarda bu ön yargının oluşmasında geçerli nedenler vardır

Pyoderma gangrenosum associated with Behçet's disease

[Abstract Not Available

Sever Disease: An Important Cause of Heel Pain in Children; Case Report

Çocuklardaki topuk ağrısının en sık nedeni kalkaneal apofizittir ve Sever hastalığı olarak tanımlanmıştır. Tipik olarak hızlı büyüme evresindeki çocuklarda ve egzersiz sezonunun başlangıcında görülür. Sadece çocuklardaki topuk ağrısı ile ilişkilidir ve puberteden sonraki dönemde görülmez. Topuk ağrısı ile başvuran bir çocuk hastada ayırıcı tanıda aşil tendiniti, retrokalkaneal bursit, kalkaneal stres kırığı, kalkaneal kistler, osteomiyelit ve plantar fasiit göz önünde bulundurulmalıdır. İyi bir klinik değerlendirme ile ayırıcı tanıda yer alan diğer nedenler Sever hastalığından ayrılır. Sık karşılaşılan bir klinik tablo olmasına rağmen Sever hastalığı hakkında ulusal ve uluslararası literatürde oldukça az dokümantasyon bulunmaktadır. Yazımızda bilateral topuk ağrısı ve aksayarak yürüme şikayetleri ile başvuran 12 yaşındaki erkek hasta eşliğinde, hastalığın, belirti ve bulgularını, tanısal yaklaşımlarını ve tedavi protokollerini güncel literatürler eşliğinde sunmayı amaçladık.Calcaneal apophysitis is the most common cause of heel pain in children and described as "Sever disease". Sever disease typically occurs during a growth spurt and at the beginning of a new sport season. The disease is associated with only the heel pain in children and does not occur after puberty. In a child presenting with heel pain, the differential diagnosis may include achilles tendonitis, retrocalcaneal bursitis, calcaneal stress fractures, calcaneal cysts, osteomyelitis, and plantar fasciitis. Other reasons included in the differential diagnosis can be ruled out with a well-performed clinical evaluation. Although Sever disease is a common clinical entity there are quite a few documentations about this disease in national and international literature. In this article we aimed to present a 12-year-old male patient who presented with complaints of bilateral heel pain and limping, and to evaluate signs and symptoms, diagnostic approaches and treatment protocols of the disease in the light of current literature

The assessment of knowledge level about their disease in patients with rheumatoid arthritis

Amaç: Bu çalışmada Romatoid Artrit (RA) tanısı ile tedavi görmekte olan olguların, hastalıkları konusundaki bilgi düzeylerinin belirlenmesi ve hastaların bilgi düzeyi ile hastalık aktivitesi arasındaki ilişkinin değerlendirilmesi amaçlandı.Yöntemler: Çalışmaya 2010 ACR/EULAR Romatoid Artrit Klasifikasyon Kriterleri'ne göre RA tanısı konulmuş 50 olgu alındı. Hastaların demografik özellikleri kaydedildi. RA hakkındaki bilgi düzeylerini değerlendirmek için, RA hastaları için tasarlanmış olan Patient Knowledge Questionnaire (PKQ)'in Türkçe çevirisi, RA aktivitesini değerlendirmek için Günlük Aktivite Skoru (DAS-28), fonksiyonel durum değerlendirmesi için Sağlık Değerlendirme Anketi (SDA) ve ağrı değerlendirmesi için Görsel Analog Skala (VAS) kullanıldı. Bulgular: Çalışmaya alınan 36 kadın ve 14 erkek RA hastasının ortalama yaşı 57,212,2, ortalama hastalık süresi 6,25,8 yıl idi. RA hastaların PKQ'nun etiyoloji, semptom ve laboratuvar testlerini içeren bileşeni için ortalama puan 3,2 (maksimum değer 9), medikasyon bileşeni için ortalama puan 2,9 (maksimum değer 7), egzersiz bileşeni için ortalama puan 2,4 (maksimum değer 7), eklemlerin ve enerjinin korunması bileşeni için ortalama puan 2,4 (maksimum değer 7) ve toplam ortalama puan 10,9 (maksimum değer 30) bulundu. PKQ puanları ile SDA, DAS-28 ve VAS parametreleri arasında korelasyon izlenmezken, hastaların eğitim düzeyi ve hastalık süresi değerleri ile PKQ puanları arasında pozitif yönde korelasyon mevcuttu.Sonuç: Çalışmamızda RA olgularında hastalık bilgi düzeyi ile hastalık aktivitesi ve fonksiyonel durum arasında belirgin bir ilişki saptanmamıştır. Ancak elde edilen sonuçlara göre hastalık bilgi düzeyleri düşük bulunmuştur. RA olguları hastalıkları konusunda daha fazla eğitim ve bilgilendirmeye ihtiyaç duymaktadırlarObjective: This study aims to evaluate, the level of knowledge about the disease of patients with rheumatoid arthritis (RA) and its relationship with the disease activity.Methods: A total of 50 patients with RA, diagnosed according to 2010 ACR/EULAR Rheumatoid Arthritis classification criteria, included in this study. Demographic features of patients were recorded. Turkish version of Patient Knowledge Questionnaire (PKQ) used to evaluate the level of knowledge about the disease of patients with RA. Daily activity score (DAS-28), Health Assessment Questionnaire (HAQ) and visual analog scale (VAS) were used to evaluate the activity of the disease.Results: The mean age of patients was 57.2±12.2 (36 females and 14 males). The mean of disease duration was 6.2±5.8 years. The mean was 3.2 (maximum value 9) for etiology, symptom and laboratory components, the mean of medication component: 2.9 (maximum value 7), the mean of exercise component: 2.4 (maximum value 7), the mean of protection of joints and energy component: 2.4 (maximum value 7) of PKQ. The total mean point was 10.9 (maximum value 30). There was no correlation between PKQ points and HAQ, DAS-28 and VAS parameters but there was a positive correlation between disease duration and PKQ points.Conclusion: The results of the study show no relationship between level of knowledge about the disease and disease activity and also functional status. On the other hand the level of knowledge about disease of patients with RA is very low. The results show the need for education programs and informative activities about RA. J Clin Exp Invest 2014; 5 (3): 429-43

The Effects of Lockdowns and Restrictions During the COVID-19 Pandemic: Perspectives and Experiences From Ankylosing Spondylitis patients.

OBJECTIVE: The COVID-19 pandemic has been affecting our world and all people for 2 years and It has been the subject of many studies that have been published in the literature. Common result of these studies is that the pandemic has increased people's stress levels and also many papers report the negative impact of the pandemic on private patient populations, such as those with chronic diseases, but there are no clinical studies in Turkey that have revealed the effects of pandemic restrictions on patients with rheumatic diseases yet. Our study aims to evaluate the effects of quarantine and restrictions imposed during the COVID-19 pandemic on patients with Ankylosing Spondylitis. METHOD: This study was carried out in the USAK province of Turkey with patients with ankylosing spondylitis aged 18-65 years. After a detailed literature review, a 35-question questionnaire was prepared. This survey was aimed at determining the treatment routines and habits of patients during the COVID-19 restriction period, such as exercise and nutritional status. At the same time, the effects of the closure and restriction period on the mental health of patients were investigated.During this period, the availability of doctors and medicines of patients was questioned. RESULTS: All participants reported an impact of lockdown. 43.7% reported lesser exercising levels than before the lockdown. These patients mainly consumed more vitamin C (65.7), as media advice for the public. However, despite specialist advice, some patients consumed more alcohol (21.4%). 78% of the patients reported sleep-wake rhythms markedly changed under restriction and the majority of patients could not go to a rheumatologist for follow-up. CONCLUSION: The majority of the AS did not consult specialists or physicians during the lockdown period but most of them continued their medications to control the disease activity

Common mistakes in the dual-energy x-ray absorptiometry (dxa) in turkey. A retrospective descriptive multicenter study

Background: Osteoporosis is a widespread metabolic bone disease representing a global public health problem currently affecting more than two hundred million people worldwide. The World Health Organization states that dual-energy X-ray absorptiometry (DXA) is the best densitometric technique for assessing bone mineral density (BMD). DXA provides an accurate diagnosis of osteoporosis, a good estimation of fracture risk, and is a useful tool for monitoring patients undergoing treatment. Common mistakes in BMD testing can be divided into four principal categories: 1) indication errors, 2) lack of quality control and calibration, 3) analysis and interpretation errors, and 4) inappropriate acquisition techniques. The aim of this retrospective multicenter descriptive study is to identify the common errors in the application of the DXA technique in Turkey. Methods: All DXA scans performed during the observation period were included in the study if the measurements of both, the lumbar spine and proximal femur were recorded. Forearm measurement, total body measurements, and measurements performed on children were excluded. Each examination was surveyed by 30 consultants from 20 different centers each informed and trained in the principles of and the standards for DXA scanning before the study. Results: A total of 3,212 DXA scan results from 20 different centers in 15 different Turkish cities were collected. The percentage of the discovered erroneous measurements varied from 10.5% to 65.5% in the lumbar spine and from 21.3% to 74.2% in the proximal femur. The overall error rate was found to be 31.8% (n = 1021) for the lumbar spine and 49.0% (n = 1576) for the proximal femur. Conclusion: In Turkey, DXA measurements of BMD have been in use for over 20 years, and examination processes continue to improve. There is no educational standard for operator training, and a lack of knowledge can lead to significant errors in the acquisition, analysis, and interpretation

Assessment of the Relationship Between Vitamin D Level and Non-specific Musculoskeletal System Pain: A Multicenter Retrospective Study (Stroke Study Group)

Objective: In this study, it was aimed to evaluate the relationship between vitamin D level and pain severity, localization and duration in patients with non-specific musculoskeletal pain. Materials and Methods: Patients who applied to physical medicine and rehabilitation outpatient clinics due to non-specific muscle pain in 19 centers in Turkey were retrospectively screened. Three thousand four hundred fourpatients were included in the study, whose pain level was determined by visual analog scale (VAS) and the painful region, duration of pain and vitamin D level were reached. D group was found to be D deficient (group 1) when 25 (OH)D level was 20 ng/mL or less and group D 2 (vitamin D deficiency) was higher than 30 ng/mL (group 3). The groups were compared in terms of pain duration, localization and severity. In addition, the correlations of pain localization, severity and duration with vitamin D levels were examined. Results: D vitamin deficiency was detected in 2202 (70.9%) of 3 thousand four hundred and four registered patients, and it was found that vitamin D deficiency in 516 (16.6%) and normal vitamin D in 386 (12.4%). The groups were similar in terms of age, body mass index, income level, duration of complaint, education level, family type and working status (p>0.05). There was no statistically significant difference between groups in terms of VAS, pain localization and duration scores (p>0.05). Conclusion: Our study shows that vitamin D deficiency in patients with nonspecific musculoskeletal pain is not associated with the severity and duration of pain