Would FRAX define the high fracture risk if the patients were evaluated the day before hip fracture?

Objective: The aim of this study was to evaluate the 10-year major osteoporotic and hip fracture risks in patients with a recent hip fracture. Material and Methods: The study population comprised 58 patients (32 male and 26 female, mean age 79.1 years) with a recent hip fracture. A bedside questionnaire including fracture risk assessment tool (FRAX®) variables and fall frequency was administered to the patients. The FRAX® 10-year major osteoporotic and hip fracture risks were calculated. Statistical analyses were performed to compare different age groups (60–69 years, 70–79 years, and ≥80 years). Results: The mean 10-year major osteoporotic and hip fracture risks were 13.9% and 78%, respectively. If the National Osteoporosis Foundation guidelines were taken into account according to major osteoporotic and hip fracture risks using FRAX® the day before the fracture, treatment would not be initiated in 75.8% and 18.9% of patients, respectively. There were significant differences between the age groups according to the 10-year major osteoporotic and hip fracture probability and fall frequency (p<0.001, p<0.001, and p=0.005, respectively). Conclusion: In our study group, the FRAX® 10-year major osteoporotic fracture probability had an underestimation in younger patients with a history of frequent falling and did not seem to improve the definition of high-risk patients. The 10-year probability of hip fracture by the FRAXObjective: The aim of this study was to evaluate the 10-year major osteoporotic and hip fracture risks in patients with a recent hip fracture. Material and Methods: The study population comprised 58 patients (32 male and 26 female, mean age 79.1 years) with a recent hip fracture. A bedside questionnaire including fracture risk assessment tool (FRAX®) variables and fall frequency was administered to the patients. The FRAX® 10-year major osteoporotic and hip fracture risks were calculated. Statistical analyses were performed to compare different age groups (60–69 years, 70–79 years, and ≥80 years). Results: The mean 10-year major osteoporotic and hip fracture risks were 13.9% and 78%, respectively. If the National Osteoporosis Foundation guidelines were taken into account according to major osteoporotic and hip fracture risks using FRAX® the day before the fracture, treatment would not be initiated in 75.8% and 18.9% of patients, respectively. There were significant differences between the age groups according to the 10-year major osteoporotic and hip fracture probability and fall frequency (p<0.001, p<0.001, and p=0.005, respectively). Conclusion: In our study group, the FRAX® 10-year major osteoporotic fracture probability had an underestimation in younger patients with a history of frequent falling and did not seem to improve the definition of high-risk patients. The 10-year probability of hip fracture by the FRAX® tool can classify populations at risk more effectively. tool can classify populations at risk more effectively. © 2015 by Turkish Society of Physical Medicine and Rehabilitation

The association of calcaneal spur length and clinical and functional parameters in plantar fasciitis

Introduction: Plantar fasciitis (PF)is the most common cause of plantar heel pain. Despite many treatment alternatives for heel spur, the association of calcaneal spur size with clinical and functional parameters is inconclusive. The objective of this study to investigate the correlation of calcaneal spur length with clinical findings and functional status documented with Foot Function Index in patients with plantar fasciitis. Methods: We performed power analysis for the sample size estimation. 87 patients with PF were scrutinized to reach the estimated patient number 75. Computer-aided linear measurements were done for spur length from tip to base in milimeters. Perceived pain intensity was evaluated by visual analog scale (VAS). Patients were asked to rate the pain experienced on a 10-cm VAS. Foot function index was applied to the patients to evaluate pain, disability and activity limitation of the patients. Results: Of the 75 participants, 24 were males (32%) and 51 were females (68%). The mean age was 47 ± 10 years (range 30-65 years). The mean calcaneal spur length was 3.86 ± 3.36 mm (range between 0 and 12.2). Calcaneal spur length was significantly correlated with age (p = 0.003), BMI (p = 0.029), symptom duration, (p = 0.001) VAS (p = 0.003), and FFI total score (p < 0.001). Discussion: Our study demonstrated that length of the calcaneal spur is significantly correlated with age, BMI, symptom duration, perceived pain, FFI pain and disability subscores, and FFI total scores. Conclusion: The size of the calcaneal spur is an important parameter correlated with pain and functional scores in PF. © 2015 IJS Publishing Group Limited

EFFECTIVENESS OF SUPERVISED RESISTIVE EXERCISE AND HOME-BASED EXERCISE TRAINING ON LOWER LIMB MUSCLE STRENGTH IN PATIENTS WITH KNEE OSTEOARTHRITIS: A LONG-TERM COMPARATIVE STUDY

World Congress of the Osteoarthritis-Research-Society-International (OARSI) on Osteoarthritis -- MAR 31-APR 03, 2016 -- Amsterdam, NETHERLANDSWOS: 000373538800849Twenty-six patients with knee OA (Kellgren & Lawrence grade 2 or 3), aged 53,86 ± 5,33 years participated in this study. All of the patients were informed about OA risk factors, pathogenesis, prognosis, modification of daily living activities during a 2-hour long patient education lecture. Participants were then assigned at random to one of two groups as home-based strength training group (HEG) (n ¼ 13) and resistive exercise training group (REG) (n ¼ 13). Both exercise programs include the same or similar exercises and aimed at increasing lower limb strength (hip, knee and ankle muscles). All subjects performed three months exercise training. The subjects in the HEG were given strength exercise training and instructed to perform the exercise program three times a week for three months at home. And also, they received one session monthly supervised exercise training for progression. Progression in exercise training obtained with elastic bant. The REG received a supervised program three times a week for three months at indoor resistive exercise station. Patients in both groups performed 10 minutes warm-up period and cool-down period. The strength of quadriceps femoris, hamstrings, hip abductors, hip adductors, and gastrocnemius muscles assessed by using handheld dynamometry by the same investigator. Muscle strength of participants was assessed at baseline, 12 weeks and 24 weeks (follow-up).Osteoarthritis Research Society Internationa

Investigation of the effect of low frequency transcutaneous electrical nerve stimulation on central pain modulation by functional magnetic resonance imaging

AMAÇ VE HİPOTEZ: Ağrıæ tarihi insanlık tarihi kadar eski olan ve tedavisi için prehistorik dönemlerden beri mücadele edilen bir duyudur. Ağrı kontrolü için nörostimülasyon tekniklerinin kullanımı da antik çağlarda başlamıştır. Günümüzde ağrı tedavisinde en sık kullanılan nörostimülasyon tekniklerinden biri transkutanöz elektriksel sinir stimülasyonu (TENS)'tir. TENS, birçok kronik ya da akut ağrılı durumda kullanılan analjezik etkili, alçak frekanslı bir akımdır ve kullanılan akımın şiddeti ve frekansına göre farklı tipleri bulunmaktadır. TENS'in analjezik etkisini gösteren çok sayıda çalışma olmasına rağmen bu çalışmaların çoğunun kanıt değeri azdır. Ancak son yıllarda yapılan meta analiz ve derlemelerle bölgesel etkinliğini gösteren kanıtlar bildirilmeye başlanmıştır. Bu çalışmanın amacı, omuz ağrısı modelinde düşük frekanslı TENS uygulamasının santral ağrı algılaması üzerine fonksiyonel manyetik rezonans görüntüleme (fMRG) ile gösterilebilir objektif bir etkisi olup olmadığının araştırılmasıdır. YÖNTEM: Çalışmaya Dokuz Eylül Üniversitesi Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı'na omuz ağrısı yakınması ile başvuran, hikaye ve fizik muayene ile omuz subakromiyal sıkışma sendromu tanısı konulan 20 hasta alındı. Tüm hastaların pasif omuz internal rotasyonu ağrılı idi. Hiçbir hasta daha önce fizik tedavi almamıştı. Hastalar iki gruba randomize edildi. Tüm hastalara ağrılı oldukları pasif omuz internal rotasyon pozisyonunda fMRG yapıldı. Daha sonra birinci gruba 30 dakika 250 µs, 3 Hz düşük frekanslı TENSæ ikinci gruba da 30 dakika elektrotların bağlandığı ancak cihazın açılmadığı sahte TENS uygulandı. Uygulamalardan hemen sonra aynı pozisyonda ikinci fMRG yapıldı. Fonksiyonel manyetik rezonans görüntüleme ile elde edilen verilerin analizi istatistiksel parametrik haritalama (statistical parametric mapping: SPM) kullanılarak radyologlar tarafından yapıldı. Literatürde ağrı algılamasında rolü olduğu bildirilen on santral ilgili alan seçilerek bilateral değerlendirildi. Hastaların görüntülemeler sırasında, ağrılı uyaran verildiğinde hissettikleri ağrı on milimetrelik vizüel analog skala (VAS) ile değerlendirildi. BULGULAR: Düşük frekanslı TENS uygulanan grupta VAS değerlerinde, tedavi sonrasında istatistiksel olarak anlamlı azalma oldu. Düşük frekanslı TENS uygulanan grupta, fMRG'de ilgili alandaki aktivasyon şiddetini gösteren Z skorlarının grup içi analizi yapıldığında kontralateral primer duyusal korteks, bilateral kaudal anterior singulat korteks, ipsilateral suplementer motor alan aktivitesindeki azalma istatistiksel olarak anlamlı bulundu. VAS değerindeki değişim ile kontralateral talamus, prefrontal korteks ve ipsilateral posterior paryetal korteks aktivitesi arasında istatistiksel olarak anlamlı korelasyon bulundu. Sahte TENS uygulanan grupta VAS değerlerinde ve ilgili alanların aktivitelerinde anlamlı değişiklik bulunmadı. SONUÇ: Bu çalışmada, omuz ağrısı olan hastalara tek seans düşük frekanslı TENS uygulaması ile ağrı VAS değerlerinde azalma sağlandı. Düşük frekanslı TENS uygulaması ile diskriminatif ağrı algısında rolü olduğu bilinen kontralateral primer duyusal korteks aktivitesinde azalma olduğu fMRG ile gösterildi. Bu bize TENS tedavisinin serebral düzeyde objektif olarak dökümente edilebilen bir analjezik etkisi olduğunu düşündürttü. Ağrı algılamasında diskriminatif ve affektif rolü olan anterior singulat korteks kaudal kesiminde bilateralæ ağrıya oluşturulan motor yanıtı temsil eden suplementer motor alanda da ipsilateral azalma olması düşük frekanslı TENS uygulamasınınæ hissedilen ağrıda azalma ile birlikte santral ağrı algılamasının diskriminatif, affektif ve motor boyutunu etkilediğini düşündürttü. OBJECTIVE AND HYPOTHESIS: The history of pain is as old as human history and its treatment is a struggle since prehistoric times. The use of neurostimulation techniques for the control of pain started in ancient ages. Nowadays one of the most frequently used neurostimulation techniques is transcutaneous electrical nerve stimulation (TENS). Transcutaneous electrical nerve stimulation is a low frequency analgesic current that is used in many acute and chronic painful states. There are different subtypes of TENS according to intensity and the frequency of the current. Altough there are many studies reporting analgesic effect of TENS, most of them have poor level of evidence. However recent meta-analyses and reviews have started to report evidence for local efficacy of TENS. The aim of this study is to investigate whether low frequency TENS has objective effect on central pain modulation that can be documented by functional magnetic resonance imaging (fMRI) on shoulder pain model. MATERIAL AND METHOD: Twenty patients who applied Dokuz Eylül University Department of Physical Medicine and Rehabilitation with symptom of shoulder pain and diagnosed as shoulder subacromial impingement syndrome according to history and physical examination were enrolled in the study. None of the patients had physical treatment before. Patients were randomized in two groups. All the patients had fMRI while the affected shoulder was positioned in the painful internal rotation position. Then 250 µs, 3 Hz low frequency TENS was applied to the patients in the first group for 30 minutes. For the second group 30 minutes sham TENS, where the electrodes were positioned and current was closed, was applied. Second fMRI was performed in the same position immediately after the low frequency TENS or sham TENS application. The data of the fMRI images were analysed by radiologists using statistical parametrical mapping (SPM). Ten central regions of interest that were reported to role in pain perception in literature were chosen and analysed bilaterally. Perceived pain intensity during fMRI was evaluated with ten milimeter visual analog scale (VAS). RESULTS: In the low frequency TENS group there was statistically significant decrease in VAS values. The intergroup analysis of Z values which represent the intensity of activation in the region of interest on fMRI images, revealed statistically significant decrease in the activity of contralateral primary sensory cortex, bilateral caudal region of anterior cingulate cortex and ipsilateral supplementary motor area. There was statistically significant correlation between the change of VAS value and change of activity in contralateral thalamus, prefrontal cortex and ipsilateral posterior paryetal cortex. In the sham TENS group there was no significant change in VAS value and activity of regions of interest. CONCLUSION: In this study one session low frequency TENS application caused statistically significant decrease in VAS values for pain in the patients having shoulder pain. Low frequency TENS application caused decrease in the activity of contralateral primary sensory cortex which is known to role in discriminative aspect of pain perception and this decrease was shown with fMRI. This finding led us to consider an objective documanteble analgesic effect of TENS on cerebral level. The bilateral decrease in the activity of caudal region of anterior cingulate cortex which has discriminative and affective role in pain perception, and decrease in the activity of ipsilateral supplementary motor area which represents motor response to pain led us consider low frequency TENS affected discriminative, affective and motor aspects of central pain perception together with decrease in perceived pain

Monoarticular hip involvement in pseudogout.

Pseudogout is the acutest form of arthritis in the elderly. Although clinical manifestations vary widely, polyarticular involvement is typical mimicking osteoarthritis or rheumatoid arthritis. Monoarticular involvement is relatively rare and is generally provoked by another medical condition. There are reported cases of hip involvement by pseudogout in monoarticular form. However, all of the cases were presented as septic arthritis. In this report, we present a case of monoarticular hip involvement mimicking soft tissue abscess. We confirmed the pseudogout diagnosis after ultrasonographic evaluation of the involved hip joint and pathological and biochemical analysis of synovial fluid analysis. Diagnosis is important to avoid unnecessary medical and surgical treatment in cases of the bizarre involvement of hip in pseudogout

Real-time sonoelastography findings in a patient with tennis leg: A promising technique in the assessment of muscle rupture

WOS: 000399965500017

The importance of patient compliance in nonunion of forearm fracture

INTRODUCTION: Studies on radius ulna shaft fractures are very important. Surgical treatment is generally administered due to the unstability caused by the dynamic effect of forearm muscles. Surgical technique, implant, osteoporosis, patient compliance can affect the surgical treatment and healing. PRESENTATION OF CASE: An 86-year-old female patient was admitted to emergency service with the complaint of protrusion of forearm implant from the skin. Physical examination revealed that 80° nonunion developed on the radial side. Therefore, protruded and exposed internal fixation materials were excised under axillary block. We used zoledronic acid as a treatment of osteoporosis with the value of −3.2 Dexa score. DISCUSSION: Complication rate is reported to be 25% in patients treated with plate fixation. Patient compliance is very crucial in forearm fractures as in all surgical procedures. Presence of comorbidities and socioeconomical status of the patient are important factors in fracture healing. CONCLUSION: This case emphasizes the importance of compliance of the patient to the follow-up after surgical treatment of forearm fracture

Investigatıon 17. of the financial performance of a private chain hospital group by dupont analysis technique

Bu çalışmanın amacı özel bir zincir hastane grubunun finansal performansının DuPont analizi tekniği ile incelenmesidir. Çalışmada söz konusu zincir hastane grubunun 2017, 2018 ve 2019 yıllarına ait finansal verileri kullanılmıştır. Çalışmada yer alan finansal veriler, ilgili özel hastane grubunun web sitesinden ve Kamu Aydınlatma Platformu’ndan (KAP) alınmıştır. Çalışmanın sonucunda söz konusu hastane grubunun 2017, 2018 ve 2019 yıllarında aktif ve özsermaye karlılığının pozitif olduğu ancak bu oranlarda bir önceki yıllara göre azalış olduğu görülmüştür. Yapılan değerlendirme sonucunda bu azalışların nedenlerinin bir önceki yıla göre aktif karlılığındaki (ROA) azalış ve ile özsermaye çarpanındaki artıştan kaynaklandığı sonucuna varılmıştır. Özsermaye çarpanının yıllar itibariyle artması, borçlanmanın dolayısıyla da finansal riskin artması anlamına geldiğinden dolayı, söz konusu hastane grubuna sermaye yapısı içinde yabancı kaynakların payının azaltılarak özkaynak payının artırılması önerilebilir.The aim of this study is to analyze the financial performance of a private chain hospital group with DuPont analysis technique. In the study, the financial data of the chain hospital group for the years 2017, 2018 and 2019 were used. The financial data included in the study were obtained from the website of the relevant private hospital group and from the Public Disclosure Platform (KAP). As a result of the study, it was seen that the hospital group in question had positive return on assets and return on equity in 2017, 2018 and 2019, but these rates decreased compared to the previous years. As a result of the evaluation, it was concluded that the reasons for these decreases were the decrease in the return on assets (ROA) compared to the previous year and the increase in the equity multiplier. Since the increase in the equity multiplier over the years means an increase in borrowing and thus the financial risk, it can be suggested to increase the equity share of the hospital group by reducing the share of foreign resources in the capital structure

Effects of lower limb exercise training with whole body vibration on femoral articular cartilage in patients with knee osteoarthritis

World Congress of the Osteoarthritis-Research-Society-International (OARSI) on Osteoarthritis -- MAR 31-APR 03, 2016 -- Amsterdam, NETHERLANDSWOS: 000373538800885Osteoarthritis (OA) is the most common degenerative joint disease leading to typical degradation of articular cartilage. Vibrations produced in oscillating/vibratory platform generate whole body vibration (WBV) exercises, which are important in sports, as well as in physiotherapy treatment. WBV exercise is a mechanically and biologically potential stimulus and a feasible, curative strength-exercise technique. Validity and reproducibility of ultrasonography (US) in detecting joint structural pathology in OA was reported. The aim of this study was to investigate the effects of lower-limb exercise training with WBV on femoral articular cartilage thickness in patients with knee OA by using US.Osteoarthritis Research Society Internationa