Diagnostic approach to low back pain

Low back pain is an important cause of pain referrals in the primary care setting. Overall, 85% of initial admissions are considered to be nonspecific low back pain that resolves in a few weeks without the need for additional evaluation. Myofascial pain, lumbar disc herniation, spinal stenosis, facet joint and disc degeneration, and sacroiliac joint pathologies are common causes of mechanical low back pain. Non-mechanical low back pain includes infections of the vertebral corpus and disc, malignant tumors and metastases, and inflammatory diseases. Red flag symptoms suggestive of serious diseases should be evaluated in all patients with low back pain, and the diagnosis process should be accelerated in patients with these symptoms. The so-called "yellow flags" associated with chronic low back pain include psychosocial factors. In the diagnosis process, pain relief is observed in patients with non-specific low back pain without the need for imaging methods. Laboratory tests and imaging methods can be used to distinguish other causes of low back pain

An assessment of marital adjustment in patients with rheumatoid arthritis

Aim To investigate marital adjustment in patients with rheumatoid arthritis and factors affecting this. Methods A total of 32 patients diagnosed with Steinbrocker class 1-2 rheumatoid arthritis and 32 healthy individuals from a similar age group were included. Sociodemographic characteristics, the Beck Depression Inventory (BDI), short–form 36(SF-36) and the dyadic adjustment scale (DAS) were evaluated in both groups. A visual analogue scale (VAS), the disease activity score 28 (DAS28) and a health assessment questionnaire (HAQ) were also investigated in the patient group. Results Mean ages were 46.5±9.2 years in the patient group and 47.7±8.1 in the control group (p=0.5). No significant difference was determined between the two groups in terms of sociodemographic characteristics. No statistically significant correlation was observed between erythrocyte sedimentation rate (ESR), patient and physician global VAS, DAS28, HAQ and morning stiffness and DAS total score. Comparison of DAS subunits revealed a significant difference in dyadic satisfaction and affectional expression in the patient and control groups (p=0.046 and p=0.037). A statistically significant negative correlation was observed between duration of the disease and marital adjustment (p=0.01;r= -0.58). Conclusion Due to its progressive and prolonged course rheumatoid arthritis can also affect individuals’ social relationships besides restricted daily living activities. Activation of rheumatoid arthritis did not affect marital adjustment in this study, but adjustment decreased with duration of the disease

Comparison of radiological changes in symphysis pubis and disease activity parameters in male patients with ankylosing spondylitis

Introduction: To determine the prevalence of involvement of symphysis pubis among male patients with ankylosing spondylitis (AS) and to analyze the relationship among this involvement, demographic data, clinical activity of the disease and radiological findings. Methods: Overall, 73 male patients diagnosed with AS who visited our clinic for follow-up were included in the study. In this retrospective study, clinical and radiological parameters were collected. In clinical evaluation, vertebral Visual Analog Scale (VAS) score, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Metrology Index (BASMI) and Bath Ankylosing Spondylitis Functional Index (BASFI) were used. In AP pelvis radiography, symphysis pubis changes were rated as 0–4. Modified Stoke Ankylosing Spondylitis Spinal Score (M-SASSS) was calculated from the cervical and lumbar lateral radiography images. Results: Symphysis pubis involvement was radiologically observed in 45 patients (61.7%). The mean age (43.9 ± 12.6) of patients with symphysis pubis involvement was higher than the average (36.9 ± 9.0) of patients without involvement (p = 0.026). Average M-SASSS of patients with symphysis pubis involvement (15.9 ± 11.9) was higher than the average of patients without involvement (8.4 ± 7.4), and there was a significant positive correlation between symphysis pubis involvement and M-SASSS (p=0.002). BASDAI and BASMI averages of patients were not significant (p = 0.973 and p = 0.105, respectively). Conclusion: Symphysis pubis involvement is a common manifestation of AS and can be used to predict vertebral radiological involvement. Keywords: Ankylosing Spondylitis, Symphysis Pubis, Modified Stoke Ankylosing Spondylitis Spinal Scor

Effect of Using High-Speed Drill in Anterior Cervical Discectomy and Fusion

CONCLUSION: Either high-speed drill or curette can be chosen for the osteophytectomy and discectomy stages of anterior cervical discectomy operations

The protective effect of Papaverine and Alprostadil in rat testes after ischemia and reperfusion injury

ABSTRACT Objective: To investigate the effect of papaverine and alprostadil on testicular torsion-detorsion injury in rats. Materials and Methods: A total of 40 male Wistar-Albino rats were used in this study. Four hours of right testicular torsion was applied to each group, excluding sham oper- ated group. The torsion-detorsion (T/D), T/D + papaverine and T/D + alprostadil groups received saline, papaverine and alprostadil at the same time as surgical detorsion, respectively. At 14 days after the surgical detorsion, ischaemic changes and the degree of damage were evaluated with Cosentino scoring and the Johnson tubular biopsy score (JTBS). Results: JTBS was determined as 8.8±2.7 in the Sham group, 5.08±1.9 in the T/D+papaverine group, 5.29±2.3 in the T/D +alprostadil group and 2.86±1.9 in the TD group. The JTBS was determined to be statistically significantly high in both the T/D + papaverine group and the T/D + alprostadil group compared to the T/D group (p=0.01, p=0.009). In the T/D + papaverine group, 3 (43%) testes were classified as Cosentino 2, 3 (43%) as Cosentino 3 and 1 (14%) as Cosentino 4. In the T/D +alprostadil group, 5 (50 %) testes were classified as Cosentino 2, 3 (30 %) as Cosentino 3 and 2 (20%) as Cosentino 4. Conclusion: The present study indicated that spermatic cord administration of alprostadil and papaverine showed a protective effect against ischemia/reperfusion injury after right-side testes torsion and histological changes were decreased after testicular ischemia reperfusion injury

Enthesitis and its relationship with disease activity, functional status, and quality of life in psoriatic arthritis: A multi-center study

Psoriatic arthritis (PsA) is an inflammatory arthritis with distinct phenotypic subtypes. Enthesitis is assigned as a hallmark of the disease, given its significant relations to disease activity and quality of life. Our objective is to evaluate the prevalence of enthesitis and its association with some clinical parameters, particularly quality of life, using data from a national registry. Patients with PsA meeting ClASsification criteria for Psoriatic Arthritis (CASPAR) were enrolled by means of a multi-centre Turkish League Against Rheumatism (TLAR) Network Project. The following information was recorded in web-based case report forms: demographic, clinical and radiographic data; physical examination findings, including tender and swollen joint counts (TJC and SJC); nail and skin involvement; Disease Activity Score-28 for Rheumatoid Arthritis with Erythrocyte Sedimentation Rate (DAS 28-ESR); Bath Ankylosing Spondylitis Disease Activity Index (BASDAI); Maastricht Ankylosing Spondylitis Enthesitis Score (MASES); Psoriasis Area Severity Index (PASI); Bath Ankylosing Spondylitis Radiology Index for the spine (BASRI-s); Health Assessment Questionnaire (HAQ); Bath Ankylosing Spondylitis Functional Index (BASFI); Health Assessment Questionnaire for the spondyloarthropathies (HAQ-s); Psoriatic arthritis quality of Life scale (PsAQoL); Short Form 36 (SF-36); Hospital Anxiety Depression Scale (HADS); Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F); and Fibromyalgia Rapid Screening Tool (FiRST) scores. The patients were divided into two groups, namely with and without enthesitis, based on the triple Likert-type physician-reported statement of ‘active enthesitis’, ‘history of enthesitis’ or ‘none’ in the case report forms. Patients with active enthesitis were compared to others in terms of these clinical parameters. A total of 1130 patients were enrolled in this observational study. Of these patients, 251 (22.2%) had active enthesitis according to the clinical assessment. TJC, HAQ-s, BASDAI, FiRST and PsAQoL were significantly higher whereas the SF-36 scores were lower in patients with enthesitis (p < 0.05). Chronic back pain, dactylitis, and tenosynovitis were more frequent in the enthesopathy group (59.4%/39%, 13.1%/6.5% and 24.7%/3.4%, respectively). Significant positive correlations between the MASES score and the TJC, HAQ, DAS 28-ESR, BASDAI, FiRST and PsAQoL scores, and a negative correlation with the SF-36 score were found. When linear regression analysis was performed, the SF-36 MCS and PCS scores decreased by − 9.740 and − 11.795 units, and the FiRST scores increased by 1.223 units in patients with enthesitis. Enthesitis is an important involvement of PsA with significant relations to quality of life determined with PsAQoL and SF-36 scores. Our study found higher frequency of dactylitis and chronic back pain, and worse quality of life determined with SF-36 and PsAQoL scores in patients with enthesitis