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

Evaluation of vitamin D levels in patients with breast cancer-related lymphedema: An observational cross-sectional study

Objective: The aim of our study was to compare plasma vitamin D levels between patients with breast cancer-related lymphedema (BCRL) and healthy population, and also to investigate the effects of socio-demographic and clinical factors and lymphedema severity on vitamin D levels. Materials and Methods: Eighty patients with BCRL [mean age 55.5 +/- 8.9 (36-81)] and age- and sex-matched 80 healthy controls [mean age 53.7 +/- 7.4 (32-70)] who were not on calcium or vitamin D supplementation were included in the study. Socio-demographic and clinical characteristics of the subjects were questioned. Plasma 25-Hydroxyvitamin D3, calcium, phosphorus, alkaline phosphatase (ALP), and parathormone (PTH) levels were evaluated. Lymphedema was classified as stage 0, I, II, or III. Results: The mean duration of lymphedema was 23.5 +/- 13.8 months. Comparisons revealed lower vitamin D levels and higher PTH and ALP levels in patients with BCRL than healthy controls. As a result of multivariate regression analysis, a significant relationship was revealed between vitamin D levels and age, breast cancer stage, and disease duration in patients with BCRL. Vitamin D levels were significantly lower and PTH levels were significantly higher in stage 3 lymphedema patients compared to stage 1. Conclusion: Vitamin D levels were detected lower in patients with lymphedema than healthy controls. Although vitamin D levels were found to be lower in patients with severe lymphedema, the multivariate regression analysis revealed that the severity of lymphedema does not have a significant effect on vitamin D levels

Gabapentin-Induced Urinary Incontinence: A Rare Side Effect in Patients with Neuropathic Pain

Gabapentin is a first-line agent for neuropathic pain management and has a favorable safety profile. The literature includes a few cases of gabapentin-induced incontinence, and most of them involved patients with epilepsy who were between the ages of 12 and 43 years. Herein, we present three patients with neuropathic pain due to different diagnoses, and, to our knowledge, these are the oldest reported cases of urinary incontinence caused by gabapentin therapy. A 56-year-old female patient who underwent hip arthroplasty developed a sciatic nerve injury and neuropathic pain postoperatively. Ten days after she began taking gabapentin to relieve her pain, she experienced daily urinary incontinence. In another instance, a 63-year-old female patient was diagnosed with complex regional pain syndrome, and seven days after the initiation of gabapentin therapy, urinary incontinence developed. In addition, a 66-year-old male patient with neuropathic pain due to cervical disc pathology complained of urinary incontinence after the onset of gabapentin therapy. After discontinuing this drug, the incontinence symptoms resolved in these patients on the seventh, the first, and the second days, respectively. Physicians who administer gabapentin should inform their patients about the potential risk of gabapentin-induced incontinence and its negative impact on quality of life