Evaluation of musculoskeletal adverse effects in patients on systemic isotretinoin treatment: A cross-sectional study

Objectives: This study aims to investigate the frequency of musculoskeletal adverse effects in acne vulgaris patients receiving systemic isotretinoin treatment. Patients and methods: Between January 2016 and December 2017, a total of 200 severe acne patients (22 males, 178 females; mean age: 21.8 +/- 0.4 years; range, 15 to 53 years) who were on isotretinoin treatment were retrospectively analyzed. Data including age, sex, body mass index (BMI), duration of disease, diagnosis, and comorbidities were recorded. Back pain severity was evaluated with the Visual Analog Scale (VAS). Results: The treatment period was mean 8.5 +/- 0.1 (range, 6 to 12) months. The dose of isotretinoin was mean 0.6 +/- 0.1 (range, 0.5 and 1) mg/kg. Musculoskeletal side effects were seen in 99 (49.5%) patients. Back pain was reported during the treatment period in 78 (78.7%) patients. The diagnosis was mechanical back pain in 31 (39.7%) and inflammatory back pain in 47 (60.3%) patients. The moderate-severe back pain group received higher cumulative isotretinoin doses than the mild back pain group (p=0.003). The BMI values did not show a significant difference between the patients with and without back pain (p=0.55). There was no significant correlation between the BMI and VAS scores (p=0.06). The VAS scores were found to be correlated with age (p=0.04). Sacroiliitis was diagnosed in four (4%) patients. One (1%) patient was diagnosed with enthesitis. Creatine kinase elevation was reported in 18 (18.1%) patients, while three (3%) patients described myalgia of mild severity. Conclusion: Low back pain is one of the most common musculoskeletal side effects of isotretinoin treatment that usually resolves with dose reduction. The cumulative dose of isotretinoin does not seem to play a role in the development of back pain, but can determine pain severity. Pain severity is directly correlated with the increasing age. Evaluation of the patients for musculoskeletal side effects during isotretinoin use is important in clinical practice, as it is a common occurrence

An Important Cause of Tetraplegia: Cervical Spondylotic Myelopathy

WOS: 000404688300008Cervical spondylotic myelopathy is a neurological disorder caused by degenerative changes in the cervical spines emerging from spinal channel narrowing. This is the most common reason of spastic tetraplegia in later phases of life. In this case report, an elderly male patient with subclinical symptoms and having cervical spondylotic myelopathy causing sudden spastic tetraplegia was presented in the light of current literature

The evaluation of opinions of the parents of children with cerebral palsy on exercise therapy applied in Special Education and Rehabilitation Centers in rural areas

WOS: 000452918400012PubMed ID: 31453536

Short-Term Effects of Steroid Injection, Kinesio Taping, or Both on Pain, Grip Strength, and Functionality of Patients With Lateral Epicondylitis A Single-Blinded Randomized Controlled Trial

WOS: 000481525600009PubMed ID: 30920398Objective The aim of the study was to compare the efficacy of steroid injection and kinesio taping (KT) in the treatment of lateral epicondylitis. Design A total number of 84 patients were randomized into three groups. Group 1 was given steroid injection, group 2 received KT, and group 3 received both. Pain was measured using a visual analog scale, functional status was measured using a quick form of the Disabilities of Arm, Shoulder and Hand questionnaire, pain-free grip strength was measured using a dynamometer, and the pressure pain threshold was measured using an algometer. All evaluations were performed before treatment and at the third and twelfth weeks after the treatment. Results Twenty-eight patients were included in each group. A statistically significant difference was found between the pretreatment and posttreatment evaluations of all groups in the third and twelfth weeks after treatment. When group 1 and group 2 were compared, there was a significant difference only in pain-free grip strength measured in the twelfth week. The results of treatment in group 3 patients were significantly better in almost all evaluation parameters compared with the other groups. Conclusion In the treatment of lateral epicondylitis, KT alone was found to be as effective as steroid injection alone. However, co-administration of steroid injection and KT is more effective compared with each treatment alone

Low-Energy Multilevel Vertebral Fracture in a Pediatric Patient during Follow-up for Idiopathic Hypercalciuria: A Case Report

WOS: 000409960500010Compared to adult studies, there are a limited number of pediatric studies exploring the effects of hypercalciuria on bone mineral density. The aim of this paper was to report a case of low-energy multilevel vertebral fracture in a pediatric patient during follow-up for idiopathic hypercalciuria (IH); it was also attempted to remind clinicians that IH-induced fractures may also occur in children. A 10-year-old male child presented to our outpatient clinic with back pain after jumping off from a height of approximately 50 cm. History of the patient showed that the patient had been followed-up for idiopathic hypercalciuria for 8 years and his father had renal stones and hypercalciuria. There was no abnormality on physical examination, with an exception for tenderness and limitation of movement in lower thoracic and lumbar vertebrae. Complete blood count and biochemical parameters were normal except for an elevated alkaline phosphatase level. Dorsal and lumbar lateral plain graphs showed compression fractures of T4, T6, T8, and L3 vertebrae, therefore, lumbar and dorsal vertebral magnetic resonance imaging (MRI), bone mineral densitometry (BMD), and vitamin D level measurement were ordered. MRI revealed acute compression fracture and medullary edema in L3; there were also chronic osteoporotic fractures in T4, T6, and T8. BMD showed a lumbar total Z score of -2.9 and the Vitamin D level was 13.7 ng/mL (10-24 ng/mL indicates moderate deficiency). A control renal ultrasonography revealed no kidney stones or calcification. The patient was prescribed polyethylene mold thoracolumbar corset and vitamin D support at a dose not to enhance hypercalciuria and nephrocalcinosis. His pain was alleviated at follow-up. Considering that most of the total bone mass is acquired at childhood, identification of causative factors and taking necessary measures at an early stage may prevent future complications of IH

Vitamin D status and association with disease activity and quality of life in patients with rheumatoid arthritis

WOS: 000486455600011Aim: The aim of this study is to determine the vitamin D level in patients with RA (Rheumatoid Arthritis) and association with clinic and laboratory parameters and quality of life. Material and Method: Out of 111 patients with RA and 107 healthy controls who were admitted to Ahi Evran University Training and Research Hospital were included in this study. Patients underwent clinical, laboratory, functional, and quality of life examination. Laboratory tests used for patient evaluations included complete blood count, erythrocyte sedimentation rate (ESR), C-reactive protein level (CRP). Disease activity was calculated by DAS28 (Disease Activity Score) and functional and quality of life was examined by RAQoL (Rheumatoid Arthritis Quality of Life), HAQ (Health Assessment Questionnaire). Larsen score was calculated to assess the radiographic damage. Results: There was no significant difference between the patient and control groups regarding age, sex and vitamin D level (p > 0.05). There were no correlation between vitamin D and Larsen score, RAQoL, HAQ, ESR, and CRP (p > 0,05). We found negative correlation between DAS28 (Disease Activity Score) and vitamin D (r = -0,416, p = 0,014). We found negative correlation between morning stiffness and vitamin D (r = -0,454, p = 0,007). Patients with RA were divided into two groups with D vitamin deficiency (0-19 ng/mL) and vitamin D (> 20 ng/mL). There was a negative correlation with morning stiffness in the group with vitamin D deficiency (r = -0,454, p = 0,007). There was a negative correlation between DAS28 score and vitamin D deficiency (r = -0.416, p = 0.014). Discussion: This study presents a negative correlation between serum vitamin D level and DAS28. Since vitamin D has autoimmune roles, deficiency or inadequacy can cause flaring in patients with RA. In the light of these findings, we recommend vitamin D supplementation

Knowledge Level and Awareness about Osteoporosis among Risk Group of Rural Women

WOS: 000409955700006Objective: Prolongation of the average life expectancy, increase in the elderly population, sedentary lifestyle, irregular eating habits; many diseases or drug usage increase predisposition to osteoporosis. The treatment costs of osteoporotic fractures in high risk groups have been increasing day by day. There are many studies which were conducted on awareness and perception of osteoporosis in the world and Turkey. However, there have been very little informing to increase awareness and perception especially in high risk groups in Turkey. In this study awareness and knowledge of rural women which have been in the risk group were evaluated. Materials and Methods: A total of 583 rural women within the risk group of primary or secondary osteoporosis were included in the study. A questionnaire consisting of 3 parts was used to evaluate the knowledge level and awareness about osteoporosis. Every correct answer was calculated as one point. Results: The mean age was 48.21 +/- 10.62 (range, 32-78) years. Five-hundred five (86.6%) of the women indicated that they have knowledge about osteoporosis. When knowledge levels of the women who had stated having knowledge about osteoporosis were analyzed; 240 (47.5%) were aware that they were in the risk group. Women who had higher education levels, had have higher awareness that they were in the risk group (p<0.001). There was a negative correlation between the total score of risk group with complication of osteoporosis awareness and age (r=-0.473, p<0.001). It has been detected that, there was a strong positive correlation between total score and education level (r=0.821, p<0.001). Conclusion: The education levels of women living in rural area are lower. The number of informative studies and community screening programmes for these women should be increased in order to reduce the morbidity, mortality and healthcare expenditure

Rare Cause of Hip Pain: Transient Osteoporosis of the Hip-Two Case Reports

Transient osteoporosis of the hip (TOH) is a rare disease affecting especially middle-aged men and women in the third trimester of pregnancy with unknown etiology. It has a benign course with spontaneous resolution. Transient osteoporosis may be confused with other diseases such as avascular necrosis. Early diagnosis is important to identify and plan correct treatment. In this report, two male cases with complaint of hip pain and difficulty in walking, which were diagnosed with TOH was presented by reviewing current literature

Which Non-Pharmacological Treatment is More Effective on Clinical Parameters in Patients With Fibromyalgia: Balneotherapy or Aerobic Exercise?

WOS: 000376969600010PubMed ID: 29900959Objectives: This study aims to determine the effects of non-pharmacological therapies, namely balneotherapy, exercise, and the combined use of balneotherapy and exercise, on total myalgic score (TMS), sleep quality, health status, and signs of depression in patients with fibromyalgia syndrome, and to compare the efficacies of these treatment programs with respect to the above parameters. Patients and methods: A total of 120 female subjects (mean age 37.21 +/- 12.45 years; range 18 to 63 years) diagnosed with fibromyalgia were enrolled. The patients were randomized into three groups with 40 patients in each (group 1: balneotherapy group, group 2: balneotherapy + exercise group, and group 3: exercise group). The patients underwent the treatment program for five days a week for a total of three weeks. Clinical parameters, Fibromyalgia Impact Questionnaire, Pittsburgh Sleep Quality Index, TMS, and Beck Depression Scale were evaluated at pre-treatment and post-treatment periods, and at the third-month control visit. Results: There were no differences between the groups with respect to Fibromyalgia Impact Questionnaire, Pittsburgh Sleep Quality Index, TMS and Beck Depression Scale scores on pre-treatment evaluation, while the combined use of balneotherapy + aerobic exercise was more effective on TMS (p<0.001), health status (p=0.009), and level of depression (p<0.001) in post-treatment evaluation. A better state of well-being with respect to sleep quality was achieved by balneotherapy and balneotherapy + exercise groups. The third-month comparisons, on the other hand, demonstrated that the balneotherapy + exercise group had a greater state of well-being with respect to TMS (p<0.001) and general health status (p<0.001). Balneotherapy + exercise and exercise therapy benefited signs of depression to a better degree (p<0.001). Balneotherapy and combined balneotherapy + exercise therapy produced more effective results in terms of sleep quality (p<0.001). TMS regressed to near baseline levels (p=0.397), while Fibromyalgia Impact Questionnaire levels rose to near baseline levels at the third-month control in the exercise therapy group (p=0.070). Conclusion: The combined application of balneotherapy + exercise therapy, which are two of the recommended non-pharmacological treatments, may have superior and more sustained effects than administering either therapy alone

Comparison of the short-term effects of the conventional motorized traction with non-surgical spinal decompression performed with a DRX9000 (TM) device on pain, functionality, depression, and quality of life in patients with low back pain associated with lumbar disc herniation: A single-blind randomized-controlled trial

WOS: 000429653400003PubMed ID: 31453485Objectives: This study aims to compare the efficiency of conventional motorized traction (CMT) with non-surgical spinal decompression (NSD) using the DRX9000 (TM) device in patients with low back pain associated with lumbar disc herniation (LDH). Patients and methods: Between March 2009 and September 2009, a total of 48 patients (29 females, 19 males; mean age 43.1 +/- 9.8 years; range, 18 to 65 years) were randomized into two groups. The first group (n=24) underwent CMT and the second group (n=24) underwent NSD for a total of 20 sessions over six weeks. The patients were evaluated before and after the treatment. Pain was assessed using the Visual Analog Scale (VAS), functional status using the Oswestry Disability Index (ODI), quality of life using the Short Form-36 (SF-36), state of depression mood using the Beck Depression Inventory (BDI), and the global assessment of the illness using the Patient's Global Assessment of Response to Therapy (PGART) and Investigator's Global Assessment of Response to Therapy (IGART) scales. Results: There was no significant difference in the evaluation outcomes before the treatment between the groups. However, a statistically significant decline was found in the VAS, ODI, and BDI scores after the treatment in both groups (all p<0.001). Except for two subgroups, no significant changes were observed in the SF-36 form. Assessment of "marked improvement" was globally most frequently reported one in both groups. No significant difference was observed in the evaluation outcomes after treatment between the groups. Conclusion: Our study results show that both CMT and NSD are effective methods in pain management and functional status and depressive mood improvement in patients with LDH, and NSD is not superior to CMT in terms of pain, functionality, depression and quality of life.Akcil Health Equipment Marketing, Import, Export Industry [DRX9000(TM)]A permission for the use of the DRX9000 (TM) spinal decompression device was granted by Akcil Health Equipment Marketing, Import, Export Industry, and Trade Limited Company which provided no contribution in the planning and implementation of the study, in the collection, analysis, and interpretation of the data, and in the preparation of this manuscript