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

Effects of inhaled corticosteroids on bone mineral density, bone formation and resorption markers and quality of life test in postmenopausal women with asthma

Amaç: Postmenopozal astımlı kadınlarda inhale kortikosteroidlerin (İKS) kemik mineral yoğunluğu, kemik yapım yıkım belirteçleri ve yaşam kalitesi üzerine etkilerinin araştırılması. Materyal ve Metod: Postmenopozal dönemdeki astım tanısı almış ve en azından 3 aydır düzenli inhale steroid kullanan hastalar ile astım tanısı olmayan ve steroid kullanmayan kontrol grubu rastgele seçildi. Kemik metabolizmasını etkileyen hastalığı olan veya ilaç kullananlar çalışmaya alınmadı. Hastalık yılı, günlük ve kümülatif inhale steroid dozu ve süresi değerlendirildi. Astımlılara solunum fonksiyon testleri (SFT) yapıldı. KMY, Z ve T skorları 4 bölgede DEXA yöntemiyle değerlendirildi. Kemik alkalin fosfataz (BAP), osteokalsin, cross laps ve 24 saatlik idrarda Ca-kreatinin oranına bakıldı. Vertebral fraktürler standart lomber radyografilerle araştırıldı. Yaşam kalitesi Kısa Form 36 (KF-36) ve WHOQOL-BREF ile değerlendirildi. İstatistiksel analizde Mann Whitney U, Spearman korelasyon testi, Ki kare testleri kullanıldı. p<0,05 anlamlı kabul edildi. Bulgular: Hasta ve kontrol gruplarına 15'er hasta alındı. Hasta ve kontrol gruplarının yaş ortalaması 51,87 (SS:4,63) ve 54,33 (SS:4,61) idi.. Her iki grubun demografik ve klinik verileri arasında anlamlı farklılık bulunmadı. KMY, T ve Z skorları, kemik belirteçleri karşılaştırıldığında, astımlılarda BAP düzeyleri anlamlı olarak daha düşük bulundu. Kümülatif İKS dozu, İKS kullanım süresi ve ortalama günlük doz ile KMY, T ve Z skorları arasında anlamlı korelasyon yoktu. Her iki grup arasında yaşam kalitesi puanlan arasında farklılık bulunmadı. Hastalık süresi ile KF-36'nın ağrı ve genel sağlık algılaması puanları arasında ve inhale steroid kullanım süreleri ile WHOQOL-KISA FORM'un (World Health Organisation Quality of Life) psikoloji puanı arasında negatif korelasyon bulundu. Sonuç: İnhale steroidler, KMY, T ve Z skorları üzerine etkili bulunmadı. BAP düzeyinin astımlılarda anlamlı olarak daha düşük bulunması kullanılan inhale steroidlerin osteoblastik fonksiyonları baskıladığını düşündürmektedir. İnhale steoid kullanan astımlı hastaların yaşam kalitelerinin kontrol grubu yaşam kalitesi düzeyinde olması steroidin olumlu etkisi olarak düşünülebilir.Subject: To assess the effects of inhaled glucocorti-costeroids on bone mineral density, bone formation and resorption markers and quality of life in postmenopausal women with asthma. Materials and Methods: Patients with asthma using inhaled steroids for more than 3 months and controls who had no asthma and not received steroids were ran&not;domly recurited. The exclusion criteria for both groups were having a disease known to affect bone metobolism or using such a drug, having autoimmun diseases. Disease duration, daily and cumulative inhaled steroid doses were noted. Pulmonary Function Tests (PFT) were performed in patients. Bone alkaline phosphatase (BAP), osteocalcin, cross laps and 24-hours urinary Ca/creatinine ratio were evaluated. Lumbar vertebral radiographies were performed to assess the vertebral fracture. The quality of life were assessed by the SF36 and WHOQOL-BREF. Mann Whitney U, Spearman correlation test and chi-squared test were used for statistical analysis. p&lt;0,05 was accepted as significant. Results: Both of the patient and the control groups con&not;sisted of 15 patients. The mean age of patients and controls were 51,87 (SD:4,63) and 54,33 (SD:4,61) respectively. There was no significant difference between the demographic and clinical data between the groups. BAP level was found significantly lower in asthma patients. There were no significant correlation between BMD, T, Z scores and duration, daily and cumulative doses of the inhaled glucocorticodteroids. There was no difference between the groups regarding the quality of life scores. The negative correlation was found between the disease duration and the pain (SF-36) and general health perception (SF-36). There was a negative correlation between the duration of the inhaled steroid and the WHOQOL psychological score. Conclusion; Inhaled steroids were not found significantly effective on BMD, T and Z scores in postmeno-pausal patients with asthma. However, BAP levels being significantly lower in asthma patients leads to a consideration that inhaled steroids inhibit osteoblastic functions. The similar quality of life levels in patients and controls may be interpreted as the positive effect of inhaled steroids on the quality of life in asthma patients

Effects of Inhaled Corticosteroids on Bone Mineral Density, Bone Formation and Resorption Markers and Quality of Life Tests in Postmenopausal Women With Asthma

Subject: To assess the effects of inhaled glucocorticosteroids on bone mineral density, bone formation and resorption markers and quality of life in postmenopausal women with asthma. Materials and Methods: Patients with asthma using inhaled steroids for more than 3 months and controls who had no asthma and not received steroids were randomly recurited. The exclusion criteria for both groups were having a disease known to affect bone metobolism or using such a drug, having autoimmun diseases. Disease duration, daily and cumulative inhaled steroid doses were noted. Pulmonary Function Tests (PFT) were performed in patients. Bone alkaline phosphatase (BAP), osteocalcin, _ cross laps and 24-hours urinary Ca/creatinine ratio were evaluated. Lumbar vertebral radiographies were performed to assess the vertebral fracture. The quality of life were assessed by the SF36 and WHOQOL-BREF. Mann Whitney U, Spearman correlation test and chi-squared test were used for statistical analysis. p<0,05 was accepted as significant. Results: Both of the patient and the control groups consisted of 15 patients. The mean age of patients and controls were 51,87 (SD:4,63) and 54,33 (SD:4,61) respectively. There was no significant difference between the demographic and clinical data between the groups. BAP level was found significantly lower in asthma patients. There were no significant correlation between BMD, T, Z scores and duration, daily and cumulative doses of the inhaled glucocorticodteroids. There was no difference between the groups regarding the quality of life scores. The negative correlation was found between the disease duration and the pain (SF-36) and general health perception (SF-36). There was a negative correlation between the duration of the inhaled steroid and the WHOQOL psychological score. Conclusion: Inhaled steroids were not found significantly effective on BMD, T and Z scores in postmenopausal patients with asthma. However, BAP levels being significantly lower in asthma patients leads to a consideration that inhaled steroids inhibit osteoblastic functions. The similar quality of life levels in patients and controls may be interpreted as the positive effect of inhaled steroids on the quality of life in asthma patients

Günlük veya haftalık alendronat veya risendronat alan postmenopozal osteoporozlu kadınlarda aylık ibandronat için hasta tercihinin değerlendirildiği açık- etiketli, prospektif, çok-merkezi, iki-aşamalı çalışma-BONCURE: Türkiye alt-çalışması

Amaç: BONCURE (Mevcut Bisfosfonat Kullanıcıları İçin Bonviva Bölgesel Avrupa Çalışması) ile daha önce günlük veya haftalık alendronat veya risendronat alan postmenopozal osteoporozu olan kadınlarda aylık ibandronat için hasta tercihinin değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Bu prospektif, açık-etiketli çalışma, iki ardışık aşamadan oluşmuştur: A (tarama) ve B (tedavi) aşaması. A aşamasına kaydolan hastalar Aday Kimlik Anketi (CIQ) tamamladı. B aşamasında, Osteoporoz Hasta Memnuniyeti Anketi (OPSAT Q) tamamladıktan sonra, hastalar 6 ay boyunca aylık oral 150 mg ibandronat aldı. Tedaviden sonra, hastalar OPSAT-Q ve Tercihi Anketi tamamladı. Bulgular: Türkiye’den 223 hasta (yaş ortalaması 63,7±9,51) A aşamasına dahil edildi. Bunların arasında, 103’ü (%46,2) en az bir CIQ sorusunu "EVET" yanıtladı. Ortalama bileşik OPSAT-Q alan puanları; kolaylık (ortalama değişiklik, 15,3±17,7 puan), yaşam kalitesi (10,4±20,4 puan), genel memnuniyet (11,9±22,7 puan) ve yan etkiler (3,3±18,8 puan) için arttı. Altıncı ayda 177 hasta (%92,7) bir kez aylık doz programını tercih etti ve %99,0’u çalışma tedavisi ile uyumlu (?%80) idi. Otuz hasta (%15,6) çoğunlukla gastrointestinal olan hafif ve orta şiddette advers olay yaşadı. Sonuç: Postmenopozal osteoporozu olan kadınlar, günlük veya haftalık bifosfonat tedavisine göre aylık ibandronatı daha çok tercih etmekte ve bu tedavi ile daha memnun ve uyumlu olmaktadır. (Türk Os te opo roz Dergisi 2012;18:1-7)Aim: BONCURE (Bonviva for Current Bisphosphonate Users Regional European Trial), aimed to evaluate patient preference with monthly ibandronate in women with postmenopausal osteoporosis who previously received daily or weekly alendronate or risendronate. Materials and Methods: This prospective, open-label study consisted of two sequential stages, Part A (screening) and Part B (treatment). Patients enrolled into Part A completed the Candidate Identification Questionnaire (CIQ). In Part B, after completing the Osteoporosis Patient Satisfaction Questionnaire (OPSATQ), patients received monthly oral ibandronate 150 mg for 6 months. Following treatment, patients completed the OPSAT-Q and Preference Questionnaire. Results: A total of 223 patients (mean age, 63.7±9.51 years) were enrolled in Part A from Turkey. Among them, 103 (46.2%) answered YES" to at least one CIQ question. The mean composite OPSAT-Q domain scores increased for convenience (mean chang

Prevalence of Rheumatoid Arthritis and Spondyloarthritis in Turkey: A Nationwide Study

Objectives: This study aims to estimate the prevalence of rheumatoid arthritis (RA) and spondyloarthritis (SpA) in Turkey using the same telephone questionnaire developed for screening RA and SpA in France and used in Serbia and Lithuania. Material and methods: The study was performed in two steps. In step I, the French questionnaire was translated into Turkish and validated through a group of 200 patients (80 males, 120 females; mean age 44.0±13.1 years; range, 19 to 75 years) followed up at the rheumatology departments of University Hospitals in Antalya and Ankara. In step II, the validated Turkish questionnaire was administered face-to-face to randomly selected 4,012 subjects (1,670 males, 2,342 females; mean age 41.5±16.8 years; range, 16 to 97 years) by trained general practitioners across the country, in 25 provinces for case detection. The subjects who were suspected of having RA or SpA in accordance with the questionnaire were invited to the nearest university hospital for rheumatologic examination in order to confirm the diagnosis. Results: In step II, a total of 25 subjects (2 males, 23 females) were diagnosed as RA. The standardized RA prevalence for the general population of Turkey was calculated as 0.56% (95% confidence interval [CI]; 0.33-0.79), 0.10% (95% CI; -0.05-0.25) for males and 0.89% (95% CI; 0.51-1.27) for females. A total of 18 subjects (3 males, 15 females) were diagnosed as SpA. The standardized SpA prevalence for the general population of Turkey was 0.46% (95% CI; 0.25-0.67), 0.17% (95% CI; -0.03-0.37) for males and 0.65% (95% CI; 0.32-0.98) for females. The prevalence of RA was highest in the Northern region (2.00%) and the prevalence of SpA was highest in the Central region (1.49%). Conclusion: The prevalences of RA and SpA in Turkey are close to each other and there are significant inter-regional variations in prevalences of both RA and SpA

Prevalence of Rheumatoid Arthritis and Spondyloarthritis in Turkey: A Nationwide Study

Objectives: This study aims to estimate the prevalence of rheumatoid arthritis (RA) and spondyloarthritis (SpA) in Turkey using the same telephone questionnaire developed for screening RA and SpA in France and used in Serbia and Lithuania. Material and methods: The study was performed in two steps. In step I, the French questionnaire was translated into Turkish and validated through a group of 200 patients (80 males, 120 females; mean age 44.0±13.1 years; range, 19 to 75 years) followed up at the rheumatology departments of University Hospitals in Antalya and Ankara. In step II, the validated Turkish questionnaire was administered face-to-face to randomly selected 4,012 subjects (1,670 males, 2,342 females; mean age 41.5±16.8 years; range, 16 to 97 years) by trained general practitioners across the country, in 25 provinces for case detection. The subjects who were suspected of having RA or SpA in accordance with the questionnaire were invited to the nearest university hospital for rheumatologic examination in order to confirm the diagnosis. Results: In step II, a total of 25 subjects (2 males, 23 females) were diagnosed as RA. The standardized RA prevalence for the general population of Turkey was calculated as 0.56% (95% confidence interval [CI]; 0.33-0.79), 0.10% (95% CI; -0.05-0.25) for males and 0.89% (95% CI; 0.51-1.27) for females. A total of 18 subjects (3 males, 15 females) were diagnosed as SpA. The standardized SpA prevalence for the general population of Turkey was 0.46% (95% CI; 0.25-0.67), 0.17% (95% CI; -0.03-0.37) for males and 0.65% (95% CI; 0.32-0.98) for females. The prevalence of RA was highest in the Northern region (2.00%) and the prevalence of SpA was highest in the Central region (1.49%). Conclusion: The prevalences of RA and SpA in Turkey are close to each other and there are significant inter-regional variations in prevalences of both RA and SpA