Handheld dermatoscopy as an easy-to-use capillaroscopic instrument in rheumatoid arthritis: A cross-sectional study

Background/aim: Nailfold video capillaroscopy is considered as a reliable method for evaluating peripheral microangiopathy in rheumatologic diseases. In this study, we aimed to demonstrate the utility of handheld dermatoscopy as an easy-to-use nailfold capillaroscopic instrument in patients with rheumatoid arthritis. Materials and methods: This cross-sectional study included patients with rheumatoid arthritis and healthy subjects. A handheld dermatoscopic examination of proximal nail fold was performed in each subject. The possible correlation of capillaroscopic findings with disease activity was evaluated using the disease activity score 28 (DAS28). Results: A total of 59 patients with rheumatoid arthritis and 60 healthy subjects were enrolled in the study. The presence of capillary enlargement, avascular areas, capillary deformities, and capillary vascular anomalies in the group of patients showed a statistically significant difference when compared with the healthy subjects. No correlation was found between the nail fold capillaroscopic findings and DAS28 score. Conclusion: Hand-held dermatoscopy seems to be a useful technique in the evaluation of nail fold capillary changes. We suggest that in patients with rheumatoid arthritis, when capillaroscopic examination is needed, it can be evaluated using handheld dermatoscopy. Selected patients who showed findings using this method can be further examined with classical capillaroscopy to obtain more quantitative data. © TÜBİTAK

Comparison of the effectiveness of conventional physical therapy and extracorporeal shock wave therapy on pain, disability, functional status, and depression in patients with chronic low back pain

Objectives: The aim of this study was to compare the effectiveness of conventional physical therapy (transcutaneous electrical nerve stimulation, hot pack, and therapeutic ultrasound) and extracorporeal shock wave therapy (ESWT) on pain, disability, functional status, and depression in patients with chronic low back pain (LBP).Patients and methods: Ninety-one patients with chronic LBP were included in the study and randomized to groups that received ESWT or conventional physiotherapy; of these, 70 completed the study (37 males, 33 females; mean age: 46.4 +/- 13.3 years; range, 18 to 65 years). Outcome measures included the Visual Analog Scale, the pressure pain algometer, Oswestry Disability Index (ODI), Health Assessment Questionnaire (HAQ), fingertip-to-floor distance, and the Beck Depression Inventory. The assessments were made before treatment and at the first and 12th weeks after treatment. Results: Extracorporeal shock wave therapy was more effective than conventional physical therapy in terms of Visual Analog Scale scores, the pressure algometer, ODI, HAQ, and fingertip-to-floor distance at the first and 12th week.Conclusion: Extracorporeal shock wave therapy is superior to conventional physical therapy in terms of improving pain, spinal mobility, and functional status in patients with chronic LBP

Epicardial adipose tissue thickness and growth differentiation factor 15 in axial spondyloarthritis

Objectives:Toinvestigategrowthdifferentiationfactor-15 (GDF-15) levels and the thickness of epicardial adipose tissue (EAT) in patients with axial spondyloarthritis (axSpA) and to evaluate their relationship with functional status, disease activity, disease duration, and the type of medical treatment received by the patients. Methods: This cross-sectional study was carried out at Kırşehir Ahievran University School of Medicine between February and June 2020. Twenty-nine healthy controls and 44 patients with axSpA were included in the study. Gender, age, erythrocyte sedimentation rate, GDF-15, body mass index, complete blood count, ejection fraction, the EAT thickness, and C-reactive protein of all participants were recorded. Ankylosing Spondylitis Quality of Life Index, Bath Ankylosing Spondylitis Functional Index, the disease duration, Bath Ankylosing Spondylitis Metrology Index, and Bath Ankylosing Spondylitis Disease Activity Index scores of patients with axSpA were noted. Results: Epicardial adipose tissue thickness values (0.35±0.09 cm) in the AxSpA group were higher compared to the control group (0.26±0.06 cm) (p<0.01). Growth differentiation factor-15 levels of the control group and axSpA group were similar. The treatment received by the patients did not have a significant relationship with EAT thickness and GDF-15. Bath Ankylosing Spondylitis Functional Index scores, disease duration, and age were significantly positively correlated with GDF-15 levels. Conclusion: In this study, EAT thickness values were found to be significantly higher in the axSpA group. In addition, GDF-15 was positively correlated with age, Bath Ankylosing Spondylitis Functional Index score, and disease duration. © 2022 Saudi Arabian Armed Forces Hospital. All rights reserved

Response to Letter to the Editor: Low-Dose Dextrose Prolotherapy as Effective as High-Dose Dextrose Prolotherapy in the Treatment of Lateral Epicondylitis? A Double-Blind, Ultrasound Guided, Randomized Controlled Study

In lateral epicondylitis, angiofibroblastic hyperplasia and poor scar tissue occur in response to recurring microtrauma in the tendon, and consequently, complete healing does not take place. In vitro studies using 50% dextrose as a proliferant have shown that exposure of tenocytes to dextrose elicited an inflammatory response through the upregulation of proinflammatory markers, including interleukin 8, cyclooxygenase 2, and prostaglandin 2, and downregulation of anti-inflammatory marker growth factor b

Is Low-Dose Dextrose Prolotherapy as Effective as High-Dose Dextrose Prolotherapy in the Treatment of Lateral Epicondylitis? A Double-Blind, Ultrasound Guided, Randomized Controlled Study

Objectives: To investigate the effects of prolotherapy (PrT) on pain, functionality, clinical improvement and to compare the 5% low and 15% high dose dextrose PrT in chronic lateral epicondylitis. Design: A double-blind, parallel groups, randomized controlled study. Settings: Outpatient Clinic. Participants: Sixty patients (N=60), aged 44.30±10.31 years old, with chronic lateral epicondylitis were allocated randomly into 3 groups. Interventions: To Group 1 5% dextrose PrT, to Group 2 15% dextrose PrT, to Group 3 0.9% saline injections were done at 3 times (weeks 0, 3, 6), to the entheses of forearm extensors and annular ligament. Main Outcome Measures: The primary outcomes were handgrip strength, visual analog scale-rest (VAS-R), visual analog scale-activity (VAS-A), pressure-pain threshold, and Quick Disability of the Arm, Shoulder and Hand (Q-DASH). The secondary outcomes were clinical improvement (Disease Global Assessment Questionnaire), side effects, and complications. Primary outcomes were collected at baseline week 0, week 3, and 12. Secondary outcomes were collected at weeks 3 and 12. Results: In Group 2, VAS-A and VAS-R (at week 3), handgrip strength and pressure-pain threshold (at week 12) were significantly different than other groups (P<.05). In Groups 1 and 2, there was a difference in primary outcomes at week 12 than baseline (P[removed].05). Conclusion: In chronic lateral epicondylitis, 5% and 15% dextrose PrT is more effective in pain, handgrip strength, functionality, and clinical improvement than %0.9 saline. There was no difference in functionality, clinical improvement, side effects, and complications between the PrT groups. 15% dextrose PrT was more effective in handgrip strength and pressure-pain threshold at week 12 and pain at week 3. We recommend 15% dextrose PrT based on this study. © 2022 American Congress of Rehabilitation Medicin

Paraplegia due to missed thoracic meningioma after lumbar spinal decompression surgery: A case report and review of the literature

Spinal meningiomas are often localized to the thoracic level and symptoms from a spinal meningioma are determined by the location of the mass. We present a case of thoracic paraplegia due to a thoracic spinal cord tumor (meningioma) that was not detected during lumbar spinal decompressive surgery. Thoracic mass was detected in level of T2-3 on magnetic resonance imaging (MRI). The patient was re-operated and the patient's neurologic symptoms were partially relieved. Surgeons should know that a thoracic silent meningioma can aggrevate neurological symptoms after lumbar spinal decompression surgery and should inform their patient before surgery

Comparison of the diagnoses, the outpatient clinics they visited, and the number of visits of patients with and without a diagnosis of fibromyalgia syndrome: Do patients with fibromyalgia syndrome come to the hospital more often? [Fibromiyalji sendromu tanısı olan ve olmayan hastaların başvurdukları poliklinik bölümleri, başvuru sayıları ve aldıkları tanıların karşılaştırılması: Fibromiyalji sendromu tanısı olan hastalar, hastaneye daha mı sık geliyor?]

Summary Objectives: Fibromyalgia syndrome (FMS) has a wide spectrum of symptoms that includes all body parts. So FMS is a great imitator. This brings to mind the possibility that fibromyalgia patients visit outpatient clinics in many departments more than non-fibromyalgia patients. However, there is not enough data on this subject. This study aims to compare the number of outpatient visits of patients with FMS with those without a diagnosis of FMS and to examine their diagnoses. Methods: The diagnoses of 140 patients (70 with fibromyalgia and 70 controls), and departments of the outpatient clinics they visited were analyzed retrospectively. In the control group, patients who visited the same outpatient clinic with the complaint of knee pain, but who did not have FMS and who had never been diagnosed with FMS before, were recruited as age- and gender-matched. Results: The total number of outpatient clinic visits, as well as the number of visits to physical medicine and rehabilitation, obstetrics and gynecology, general surgery, internal medicine, and psychiatry departments, were significantly higher in fibromyalgia group patients compared to the control group. In addition, the number of diagnoses in the 5th chapter (mental, behavioral, and neurodevelopmental disorders, F01-F99) of International Classification of Diseases-10 was significantly higher in the fibromyalgia group. Conclusion: It should be kept in mind that patients with FMS visit more hospitals and outpatient clinics than other patients. Physicians and patients should be informed about this issue to reduce unnecessary health costs

Is low-dose dextrose prolotherapy as effective as high-dose dextrose prolotherapy in the treatment of lateral epicondylitis? A double-blind, ultrasound guided, randomized controlled study

© 2022 American Congress of Rehabilitation MedicineObjectives: To investigate the effects of prolotherapy (PrT) on pain, functionality, clinical improvement and to compare the 5% low and 15% high dose dextrose PrT in chronic lateral epicondylitis. Design: A double-blind, parallel groups, randomized controlled study. Settings: Outpatient Clinic. Participants: Sixty patients (N=60), aged 44.30±10.31 years old, with chronic lateral epicondylitis were allocated randomly into 3 groups. Interventions: To Group 1 5% dextrose PrT, to Group 2 15% dextrose PrT, to Group 3 0.9% saline injections were done at 3 times (weeks 0, 3, 6), to the entheses of forearm extensors and annular ligament. Main Outcome Measures: The primary outcomes were handgrip strength, visual analog scale-rest (VAS-R), visual analog scale-activity (VAS-A), pressure-pain threshold, and Quick Disability of the Arm, Shoulder and Hand (Q-DASH). The secondary outcomes were clinical improvement (Disease Global Assessment Questionnaire), side effects, and complications. Primary outcomes were collected at baseline week 0, week 3, and 12. Secondary outcomes were collected at weeks 3 and 12. Results: In Group 2, VAS-A and VAS-R (at week 3), handgrip strength and pressure-pain threshold (at week 12) were significantly different than other groups (P.05). Conclusion: In chronic lateral epicondylitis, 5% and 15% dextrose PrT is more effective in pain, handgrip strength, functionality, and clinical improvement than %0.9 saline. There was no difference in functionality, clinical improvement, side effects, and complications between the PrT groups. 15% dextrose PrT was more effective in handgrip strength and pressure-pain threshold at week 12 and pain at week 3. We recommend 15% dextrose PrT based on this study

Epicardial adipose tissue thickness and growth differentiation factor 15 in axial spondyloarthritis

Objectives: To investigate growth differentiation factor-15 (GDF-15) levels and the thickness of epicardial adipose tissue (EAT) in patients with axial spondyloarthritis (axSpA) and to evaluate their relationship with functional status, disease activity, disease duration, and the type of medical treatment received by the patients.Methods: This cross-sectional study was carried out at Kirsehir Ahievran University School of Medicine between February and June 2020. Twenty-nine healthy controls and 44 patients with axSpA were included in the study. Gender, age, erythrocyte sedimentation rate, GDF-15, body mass index, complete blood count, ejection fraction, the EAT thickness, and C-reactive protein of all participants were recorded. Ankylosing Spondylitis Quality of Life Index, Bath Ankylosing Spondylitis Functional Index, the disease duration, Bath Ankylosing Spondylitis Metrology Index, and Bath Ankylosing Spondylitis Disease Activity Index scores of patients with axSpA were noted.Results: Epicardial adipose tissue thickness values (0.35 +/- 0.09 cm) in the AxSpA group were higher compared to the control group (0.26 +/- 0.06 cm) (p<0.01). Growth differentiation factor-15 levels of the control group and axSpA group were similar. The treatment received by the patients did not have a significant relationship with EAT thickness and GDF-15. Bath Ankylosing Spondylitis Functional Index scores, disease duration, and age were significantly positively correlated with GDF-15 levels.Conclusion: In this study, EAT thickness values were found to be significantly higher in the axSpA group. In addition, GDF-15 was positively correlated with age, Bath Ankylosing Spondylitis Functional Index score, and disease duration

Tuz ve kuraklık stresinin bezelye' nin (Pisum sativum L.) çimlenme ve fide gelişimi üzerine etkileri

Sodyum klorür ve PEG 6000 (polyethylene glycole 6000) kullanılarak -2, -4, -6 ve -8 bar su tutma gücüne sahip solüsyonlarda tuz ve kuraklığın üç bezelye çeşidinin (Bolero, Sprinter ve Utrillo) çimlenme ve fide gelişimi üzerine etkileri incelemiştir. Sodyum klorür solüsyonlarının elektriksel iletkenlik (EC) değerleri 4.5, 8.8,12.7 ve 16.3 dS m"'olarak belirlenmiştir. Araştırmada, çimlenme yüzdesi, ortalama çimlenme zamanı, kök ve sürgün uzunluğu, fide yaş ve kuru ağırlıkları incelenmiştir. Araştırmada amaç, tuz ve kuraklık stresleri bakımından bezelye çeşitleri arasındaki farklılık ile tohumların tuzun toksik etkisi veya NaCl tarafından oluşturulan osmotik potansiyel nedeniyle çimlenip çimlenmediğini belirlemektir. Sonuçlar, hem tuz hem de kuraklık stresi bakımından çeşitler arasında farklılık olduğunu ortaya koymuştur. Sprinter kurak şartlarda daha iyi sonuçlar vermesine rağmen, Bolero tuz stresine daha toleranslı görünmüştür. Sodyum klorür ve PEG solüsyonları çeşitlerin fide gelişimini engellemiş ancak, NaCl' nin etkisi PEG' den daha az olmuştur. Üç çeşitte de tüm NaCl seviyelerinde çimlenmede önemli bir azalma olmazken, -6 bar PEG solüsyonunda çimlenme düşmüştür. Aynı su tutma gücüne sahip NaCl ve PEG solüsyonlarında çimlenmenin azalması tuzun toksik etkisinden çok oluşturduğu osmotik etkiden kaynaklandığı sonucuna varılabilir.The effects of salt and drought stresses at the water potentials of -2, -4, -6 and -8 bars induced by NaCl and PEG 6000 (polyethylene glycol 6000) each, on germination and early seedling growth, were investigated for 3 pea cultivars (Bolero, Sprinter and Utrillo). Electrical conductivity (EC) values of the NaCl solutions were 4.5, 8.8, 12.7 and 16.3 dS $m^{-1}$. Germination percentage, mean germination time, root and shoot length, and seedling fresh and dry weight were measured in the study. The objective was to determine genotypic differences among pea cultivars in terms of salt and drought stress and to determine factors (salt toxicity or osmotic stress due to PEG) inhibiting seed germination. The germination results revealed that the genotypes significantly differed for salt and drought stress. Bolero appeared to be more tolerant to salt stress, but Sprinter cv. gave higher values under drought stress. Both NaCl and PEG inhibited germination and seedling growth in all cultivars, but the effects of NaCl compared to PEG were less on germination and seedling growth. All cultivars were able to germinate at all NaCl levels without a significant decrease in germination, while a drastic decrease in germination was recorded at -6 bars of PEG. It was concluded that inhibition in germination at equivalent water potentials of NaCl and PEG was mainly due to an osmotic effect rather than salt toxicity