The risk factors, clinical features and associated problems of children attending the outpatient cerebral palsy clinic [Serebral palsi poliklinigine müracaat eden olgularin risk faktörleri, klinik özellikleri ve eşlik eden problemler]

Objective: The aim of this study was to determine the risk factors, clinical features and associated problems of children attending the outpatient cerebral palsy (CP) clinic. Material and Methods: Data of the 89 cases who had admitted to outpatient CP clinic between May 2005 and June 2010 was evaluated retrospectively. Results: Thirty-seven (37.1%) were girl, and 56 (62.9%) were boy of the 89 cases recruited to the study. Mean age was 84.4 ± 52.2 months. Spastic CP was the most common type with the ratio of %94.3. Spastic diplegia was the most common sub-group (47.2%). The most frequently encountered risk factor was low birth weight (48.3%), the second was premature birth (41.6%), and the third was neonatal convulsions (33.7%). The highest frequencies of additional problems were mental retardation (39.3%), speech-language pathologies (34.8%), and vision problems (31.4%), respectively. Ankle-foot orthosis or a variation was prescribed to 54.9% and reverse walker was prescribed 20.2% of the patients. Multi-level botulinum toxin-A injection were performed in 32.5% of the cases and 8.9% of them were referred for surgery. Conclusion: A close follow-up and early rehabilitation of high risk babies in the period of infancy, in which the neuroplasticity is the highest, is important. The cerebral palsy rehabilitation should be multidisciplinary and additional problems should be evaluated and treated properly. Copyright © 2010 by Türk Tibbi Rehabilitasyon Kurumu Dernegi

A comparison of reboxetine and amitryptilline in the treatment of fibromyalgia syndrome with co-morbid depressive symptoms: an open-label preliminary study = Komorbid depresif semptomları olan fibromiyalji hastalarında reboksetin ve amitriptilin tedavilerinin karşılaştırılması: Açık ön çalışma

Objective: Fibromyalgia (FM) is a chronic debilitating disorder that results in millions of dollars of heathcare costs and lost wages each year worldwide. It is a significant public health concern and new treatments are needed. In this study, we aimed to compare the effectiveness of a widely used tricyclic antidepressant for FM (amitryptylline) and one that has not yet been widely used (reboxetine) for FM in a within-subject pre-posttreatment design. Additionally, since noradrenaline (NA) is thought to play a relevant role in the antinociceptive mechanisms, we also aimed to examine the effectiveness of reboxetine as a selective NA reuptake inhibitor (NARI) in patients with fibromialgia. Methods: Twenty-one patients with fibromyalgia were randomized to receive amitiriptylline (25–75 mg/day) or reboxetine (8 mg/day). Patients were administered the Fibromyalgia Impact Questionnaire (FIQ), the Beck Depression and Anxiety Inventories (BDI, BAI), and the Hamilton Rating Scales for Depression and Anxiety (HAM-D, HAM-A) at the treatment weeks 2, 4, and 8. The intensity of the pain was recorded using a Visual Analog Scale (VAS). Results: We found both medications to be associated with improvement in pain (decreased VAS scores), FIQ scores, and depressive symptomotology. General linear model repeated measures analysis on the VAS and FIQ scores showed a significant decrease over time in both treatment groups without significant group difference or time x group interaction effect. There were no serious adverse events in both groups. Conclusions: This open trial demonstrated that either reboxetine or amitryptylline would be effective for the treatment of pain symptoms in patients with FM. Since open-label clinical effectiveness studies do not provide definitive conclusions about causality or efficacy, double blind, placebo-controlled studies in larger clinical groups are needed to reach a definitive conclusion. Our findings provide clinical researchers important information about the novel treatment options for FM

Association between serum ferritin level and fibromyalgia syndrome

Background/Objectives: Iron is essential for a number of enzymes involved in neurotransmitter synthesis. Analysis of cerebrospinal fluid in fibromyalgia syndrome (FMS) has shown a reduction in the concentration of biogenic amine metabolites, including dopamine, norepinephrine and serotonin. This study aimed to investigate the association of ferritin with FMS. Subjects/Methods: A total of 46 patients with primary FMS participated in this case-control study, and 46 healthy females who were age matched to the patients were used as the control group. Venous blood samples collected from all subjects were used to evaluate serum ferritin, vitamin B12 and folic acid levels. Results: The mean serum ferritin levels in the fibromyalgia (FM) and control groups were 27.3±20.9 and 43.8±30.8 ng/ml, respectively, and the difference was statistically significant (P=0.003). Binary multiple logistic regression analysis with age, body mass index, smoking status and vitamin B12, as well as folic acid and ferritin levels showed that having a serum ferritin level <50 ng/ml caused a 6.5-fold increased risk for FMS. Conclusions: Our study implicates a possible association between FM and decreased ferritin level, even for ferritin in normal ranges. We suggest that iron as a cofactor in serotonin and dopamine production may have a role in the etiology of FMS. © 2010 Macmillan Publishers Limited All rights reserved

Komorbid depresif semptomları olan fibromiyalji hastalarında reboksetin ve amitriptilin tedavilerinin karşılaştırılması: Açık ön çalışma

Amaç: Fibromyalji (FM) yeni tedavi arayışlarının sürdüğü önemli bir halk sağlığı sorunudur. Bu çalışmada FM tedavisinde sıklıkla kullanılan trisiklik antidepresan amitriptilin ile henüz yeterince araştırılmamış seçici noradrenalin geri alım inhibitörü reboksetinin etkilerinin karşılaştırılması amaçlanmıştır. Ayrıca noradrenalinin ağrı duyumundaki mekanizmalarla ilişkisi bakımından, seçici noradrenalin geri alım inhibitörü reboksetinin FM hastalarında etkinliğini de değerlendirmek amaçlanmıştır. Yöntem: Depresif semptomları da olan 21 FM hastası 25-75mg/gün amitriptilin ya da 8 mg/gün reboksetine randomize edildi. Hastalar başlangıç, 2,4 ve 8. haftalarda Fibromyalji Etki Anketi (FEA), Beck Anksiyete ve Depresyon Ölçekleri (BAI, BDI), Hamilton Anksiyete ve Depresyon Ölçekleri (HAM-A, HAM-D) ile değerlendirildi. Ağrı şiddeti Görsel Analog Skala (GAS) ile değerlendirildi. Bulgular: Her iki ilaç grubunda FEA ve GAS puanları ile saptanan FM belirtileri ve depresif belirtilerinde iyileşme ile ilişkili bulundu. General Lineer Model Tekrarlı Ölçümler testi, FEA ve GAS puanlarında gruplar arası fark ya da zaman x grup etkileşimi olmaksızın anlamlı azalmanın bulunuduğunu gösterdi. Her iki grupta da kayda değer ciddi yan etki gözlenmedi. Sonuç: Bu açık çalışmada gerek amitriptilinin gerekse reboksetinin FM hastalarının ağrı ve depresif semptomlarındaki iyileşme ile ilişkili olduğu gösterilmiştir. Etkililik çalışması nedenselliği ve etkinliği göstermediğinden kesin sonuçlar çıkarsamak için daha büyük gruplarda plasebo kontrollü, çift kör çalışmalara ihtiyaç vardır. Araştırmamızın bulguları FM tedavisi için yapılacak çalışmalara dair önemli ipuçları sunmaktadır.Objective: Fibromyalgia (FM) is a chronic debilitating disorder that results in millions of dollars of heathcare costs and lost wages each year worldwide. It is a significant public health concern and new treatments are needed. In this study, we aimed to compare the effectiveness of a widely used tricyclic antidepressant for FM (amitryptylline) and one that has not yet been widely used (reboxetine) for FM in a within-subject pre-posttreatment design. Additionally, since noradrenaline (NA) is thought to play a relevant role in the antinociceptive mechanisms, we also aimed to examine the effectiveness of reboxetine as a selective NA reuptake inhibitor (NARI) in patients with fibromialgia. Methods: Twenty-one patients with fibromyalgia were randomized to receive amitiriptylline (25-75 mg/day) or reboxetine (8 mg/day). Patients were administered the Fibromyalgia Impact Questionnaire (FIQ), the Beck Depression and Anxiety Inventories (BDI, BAI), and the Hamilton Rating Scales for Depression and Anxiety (HAM-D, HAM-A) at the treatment weeks 2, 4, and 8. The intensity of the pain was recorded using a Visual Analog Scale (VAS). Results: We found both medications to be associated with improvement in pain (decreased VAS scores), FIQ scores, and depressive symptomotology. General linear model repeated measures analysis on the VAS and FIQ scores showed a significant decrease over time in both treatment groups without significant group difference or time x group interaction effect. There were no serious adverse events in both groups. Conclusions: This open trial demonstrated that either reboxetine or amitryptylline would be effective for the treatment of pain symptoms in patients with FM. Since open-label clinical effectiveness studies do not provide definitive conclusions about causality or efficacy, double blind, placebo-controlled studies in larger clinical groups are needed to reach a definitive conclusion. Our findings provide clinical researchers important information about the novel treatment options for F

The effect(s) of a six-week home-based exercise program on the respiratory muscle and functional status in ankylosing spondylitis

BACKGROUN

Herpes zoster in a patient treated with adalimumab and leflunomide: Case report [Adalimumab ve leflunomid ile tedavi edilen bir hastada herpes zoster]

Herpes zoster (HZ) is one of the most common adverse effects reported in clinical trials of tumor necrosis factor (TNF) alpha antagonists. Several drugs used in the treatment of rheumatoid arthritis (RA), including cyclophosphamide, azathioprine, leflunomide, and methotrexate, have been held responsible for the development of HZ. In this report, a case of diagnosed HZ in an adult while receiving combination therapy TNF-alpha antagonist (adalimumab) and leflunomide for rheumatoid arthritis will be presented. The patient was using adalimumab and leflunomide for 18 months without any complications, at the 18th month of her follow-up, she developed an itchy skin rash on the lateral side of the left upper eyelid. Based on dermatologic examination, she was diagnosed with HZ. Systemic valaciclovir treatment was commenced at a dose of 1000mg 3 times daily for 7 days, and adalimumab was stopped. The patient recovered within 7 days without any complications. At the 2nd and 6th months of her follow up she had no swollen or tender joints, the ESR measurements were 69 mm/h and 60 mm/h, her DAS 28 scores were 2.9 and 3.1 respectively. Accordingly these findings we did not restart anti-TNF alpha treatment. Therapy of patient was continued with leflunomide 20 mg/day. Therapy with combined adalimumab and leflunomide may result in various opportunistic infections. This should be kept in mind while prescribing TNF alfa antagonists for patients who are already receiving immunosuppressant drugs. Copyright © 2009 by Türk Tibbi Rehabilitasyon Kurumu Derneg¨i

Is osteoporosis generalized or localized to central skeleton in ankylosing spondylitis?

BACKGROUND: Osteoporosis at the lumbar spine and at the femur is a well-established complication in ankylosing spondylitis (AS), but the exact mechanism and the distribution of osteoporosis are not known absolutely. OBJECTIVE: To determine whether the osteoporosis is generalized or localized to central skeleton and to examine the relation between bone mineral density (BMD) and disease activity and radiologic progression in patients with AS. METHODS: In this study, 26 patients with AS and 33 healthy controls matched for age and sex were recruited to the study. Hip and forearm BMD were measured by dual energy X-ray absorptiometry (DEXA). Laboratory and clinical disease activity parameters were documented, and anteroposterior sacroiliac radiographs were taken to determine the radiologic progression. RESULTS: The urine deoxypyridinoline levels of the patients with AS were statistically significantly higher (P = 0.02) and the serum osteocalcin levels were significantly lower with respect to controls (P = 0.03). The femoral neck and femur BMD values and T scores were significantly lower in patients with AS compared with the controls (P = 0.019, 0.003, 0.01, and 0.01, respectively). The differences in BMD values and T scores of the distal 1/3 radius between 2 groups were not statistically significant. The relation between BMD and disease activity, and radiologic progression in patients with AS could not detected. CONCLUSION: Sparing of distal regions such as the as radius suggests that osteoporosis might be due to localized effects of inflammatory activity or immobility rather than a systemic effect. Both increased resorption and decreased formation might be involved in the pathogenesis of osteoporosis. Radius BMD may not be appropriate to evaluate bone loss in patients with AS. © 2007 Lippincott Williams & Wilkins, Inc

A new modification of KAFO for assistance in knee extension

In this paper, a dynamic knee-ankle-foot orthosis (KAFO) extension assisted with elastic support, has been described which contributes to stance phase stability and swing phase freedom. The temporal distance factors including velocity, cadence, stride length, and clinical gait assessment score (CGAS) with bare foot and orthosis have been documented. The orthosis enables walking without fully immobilizing the knee. © 2007 Informa UK Ltd All rights reserved

Anti-cyclic citrullinated peptide antibodies in rheumatoid arthritis and their relationship with extra-articular manifestations = Romatoid artritte anti-siklik sitrulinli peptid antikorlar ve bunların ekstra-artiküler bulgular ile i̇lişkisi

Objectives: In this study, we investigated the relationship between extra-articular manifestations (EAM) and anti-cyclic citrullinated peptide (anti-CCP) antibodies. Patients and methods: S ixty-seven p atients (53 f emales, 1 4 males; mean age 57.4±13.5 years; range 26 to 82 years) diagnosed with rheumatoid arthritis (RA) according to the ACR (American College of Rheumatology) criteria between January 2009 - December 2009 were included in the study. The age, gender, disease duration, and EAMs (rheumatoid nodules, pulmonary nodules, pulmonary fibrosis, keratoconjunctivitis sicca) of each patient were recorded, and the anti-CCP antibody and rheumatoid factor (RF) positivity and serum RF levels were evaluated. Results: Extra-articular manifestations were present in 28 (41.8%) of the patients. Anti-CCP antibodies were present in 34 (50.7%) patients. Positivity of anti-CCP antibodies was found in 16 (57.1%) patients with EAM compared to 18 (46.2%) patients without EAM (p&gt;0.05). Rheumatoid factor positivity was found in 23 (82.1%) patients with EAM compared with 30 (76.9%) patients without EAM (p&gt;0.05). The serum levels of RF were 176.5±201.7 IU/ml in the patients with EAM, and 114.1±144.8 IU/ml in the patients without EAM (p&gt;0.05). The mean serum titers of RF were significantly higher in the patients with pulmonary fibrosis than in those without pulmonary fibrosis (237.8±204.8 IU/ml and 118.9±158.6 IU/ml respectively; p=0.036). Conclusion: It is known that EAMs increase morbidity and mortality in patients with rheumatoid arthritis. Thus, the markers that help identify patients with severe disease have an important role in making a decision for early aggressive treatment. Studies that investigate the relationship between anti-CCP antibodies and EAM have conflicting results. In this study, no relationship was found between the antibodies against citrullinated peptides and the presence of EAMs. We think that further studies with a larger sample size are necessary to evaluate the relationship between EAM and anti-CCP antibodies