The prevalence of inflammatory back pain, sacroiliitis and spondyloarthropathy in patients who underwent lumbar disc herniation surgery

Gerekçe: Romatolojik hastalıklar içerisinde ankilozan spondilit (AS), radyografik sakroiliitin gelişimi için uzun yıllar gerektiğinden en geç tanı konulan hastalıktır. Ülkemizde yapılan çok merkezli bir araştırmada AS'li hastaların yaklaşık 1/3'ünün daha önce lumbar disk hernisi (LDH) tanısı aldığı ve %7'sinin bu nedenle opere olduğu bildirilmiştir. Bu çalışmada LDH tanısı ile opere edilen hastalarda inflamatuvar bel ağrısı (İBA), AS ve diğer spondiloartrit (SpA) grubu hastalıklara ilişkin klinik belirti ve bulguların sıklığını araştırmayı amaçladık. Yöntem: 2008-2010 tarihleri arasında bir üniversite hastanesi ?Beyin ve Sinir Cerrahisi' anabilim dalında ?LDH? tanısı ile opere edilen tüm hastalar polikliniğe davet edildi. Tüm gönüllüler standart bir protokole uygun olarak muayene edildi. İBA için Calin ve Berlin kriterleri kullanıldı. Tüm hastalarda sakroilyak eklemlerin (SİE) değerlendirilmesi amacıyla pelvis grafisi çekilmesi planlandı. SpA ve AS tanısı için European Spondyloarthropathy Study Group (ESSG), Amor ve modifiye New York kriterleri (mNY) kullanıldı. Gelemeyen hastalara kabul etmeleri durumunda standart bir form kullanılarak telefon anketi yapıldı. Sonuçlar: Çalışma için yapılan taramada uygun 789 hasta tespit edildi. Bunlardan 468 hastaya (%59) en az 2 kez denenmesine karşın ulaşılamadı. Ulaşılan 321 hastadan (142 erkek [%44], ortalama yaş 49±10.8) 123'ü ile yüz yüze, 198'i ile telefon görüşmesi yapıldı. Poliklinikte görülen ve telefon görüşmesi yapılan hastaların yaş, cinsiyet, semptom süresi ve tanı yaşları benzerdi, yalnızca yüz yüze görüşmeyi kabul eden hastaların eğitim süreleri daha uzundu (9±4.4 vs 7±4.1 ve p<0.001) ve daha fazla oranda ağrılarının operasyon sonrası devam ettiğini belirttiler (%68 vs %51.7 ve p<0.001). Hastaların ortalama bel ağrısı başlangıç yaşı 34 ± 12.5, ortalama LDH tanı yaşı 41 ± 12.4 olarak bulundu. Calin kriterlerine göre 108 hastada (%33.6) ve Berlin kriterlerine göre 51 (%16.4) İBA saptandı. Çalışma grubundaki 308 kişinin değerlendirilen pelvis grafisi sonucunda sakroiliit saptanan 5 kişi (%1.2) AS tanısı için mNY kriterlerini karşılıyordu. Ek olarak yüz yüze görüşülen ve SİE manyetik rezonans görüntüleme (MRG) planlanan 34 hastanın 12'sinde MRG çekilebildi ve 4'ünde Assessement of Spondyloarthritis International Society (ASAS) tanımlamasına uygun olarak aktif sakroiliit saptandı. Böylece yüzyüze görüşülen hastalarda radyolojik görüntüleme ile sakroiliit prevalansı minimum %6.5 ((4+4)/123) olarak hesaplandı. Tüm değerlendirmelerden sonra SpA tanısı için ESSG kriterlerini 57 kişi (%17.7) ve Amor kriterlerini de 28 kişi (%8.7) karşılıyordu. Tartışma: LDH nedeniyle opere edilen hastalar arasında AS veya SpA sıklığının artmış gözükmesi dikkat çekicidir. SpA kriterlerini karşılayan hastaların çoğunda ameliyattan sonra bel ağrısının devam ediyor olması, bu grup hastaların başvurma olasılığı yüksek diğer hekim gruplarının İBA'nın nitelikleri konusunda bilinçlendirilmesinin önemine işaret etmektedir. Objective: There is considerable delay in the diagnosis of ankylosing spondylitis (AS) because of the late appearance of radiographic sacroiliitis. A previous multi-center study conducted in our country showed that approximately 1/3 of the AS patients had been diagnosed as lumbar disc herniation (LDH), and 7% of these patients had undergone operation for that disorder. In this study we aimed to evaluate the frequency of inflammatory back pain (IBP), and the clinical findings related with AS and other spondyloarthropathies (SpA) in patients who had been surgically treated for LDH. Methods: We retrieved the records of the patients who underwent LDH surgery between 2008 and 2010 in the neurosurgery clinic of our university hospital. Eligible patients were then invited to the rheumatology clinic for further evaluation. All patients were examined according to a standard protocol. A face to face interview by using a standardized questionnaire addressing all the components of IBP including Calin and Berlin criteria sets was performed. The antero-posterior plain pelvic radiographs were planned for determination of sacroiliitis. The modified New York criteria (mNY) was used for the diagnosis of AS, and Amor and/or the European Spondyloarthropathy Study Group (ESSG) criteria were used for the diagnosis of other SpAs. A telephone interview was used for patients who did/could not come to the outpatient clinic by using a standardized form. Results: There were 789 patients who underwent LDH surgery. 468 patients (59%) could not be contacted despite at least 2 attempts. We contacted 321 patients (142 Men [44.2%], mean age 49±10.8 years) face to face interview and telephone interview were conducted with 123 and 198 patients, respectively. Both groups showed similar age, sex distribution, symptom duration and age at diagnosis. However, patients who came to hospital for face to face interview reported a significantly higher number of years of education (9±4.4 vs. 7±4.1, p<0.001) and a higher frequency of continuing pain after surgery (68% vs. 51.7, p<0.001). The mean age of onset-of low back pain was 34 ± 12.5 years. The mean age of LDH diagnosis was 41 ± 12.4 years. IBP was diagnosed in 108 (33.6%). and 51 (16.4%) patients according to the Calin and Berlin criteria sets respectively. Plain pelvic radiographs were performed in 308 patients and sacroiliitis was found to be present in 5 patients (1.2%). All patients with sacroiliitis fulfilled the mNY criteria for AS. In the face to face interview group, we planned the visualization of sacroiliac joints by magnetic resonance imaging (MRI) in 34 patients, but were able to perform in only 12 patients. Of those, four had active sacroiliitis in accordance with the Assessement of Spondyloarthritis International Society (ASAS) definitions for positive MRI. The overall prevalence of radiographic sacroiliitis (MRI sacroiliitis + X-ray sacroiliitis) in the face to face interview group was 6.5% ((4+4)/123). Based on the above findings, the overall prevalence of SpA was estimated as 17.7% (57 patients) and 8.7% (28 patients) according to the ESSG and Amor criteria, respectively. Discussion: The increased prevalence of AS and SpA among patients who underwent LDH surgery is of note. Patients satisfying the SpA criteria, who had persistent back pain after the surgery, require careful evaluation by the physicians dealing with low back pain

Relationships Between Teacher Discursive Moves and Middle School Students’ Cognitive Contributions to Science Concepts

© 2019, Springer Nature B.V.This study investigated science classroom discourse in terms of the types of teacher discursive moves (TDMs) and the relationships between the types of TDMs and student-led cognitive contributions in different science concepts by considering the classroom context. An experienced seventh-grade science teacher and her 19 students were engaged in argument-based inquiry activities focusing on physics and chemistry concepts. The analysis revealed that even though the teacher used a variety of TDMs, the following four enacted TDMs were prominent: knowledge providing–evaluating, communicating, monitoring, and evaluating–judging–critiquing. There were implicit relationships between the knowledge providing–evaluating, communicating, monitoring, and evaluating–judging–critiquing moves and the students’ cognitive contributions in different science concepts. For further analysis, several video cases were selected for scrutinizing these episodes, and it was found that evaluating–judging–critiquing teacher moves interacted with classroom culture more than the other two commonly used TDMs by using comparison prompt (simple comparison), evaluation prompt (teacher-led evaluation), and resolution prompt (student–student judgements). It was observed that when the teacher increased the number of resolution prompts, the students reached greater cognitive contributions during the negotiation of physics phenomena. Recommendations were presented for the science teachers’ professional development in the sense of discourse–cognition relations

The Survival And Performance Results Of The Crossbreds Calves Of Angus, Piedmontese And Simmental Breeds With Holstein Cattle İn Adana

Better beef breeding is the goal of all beef producers. The real challenge for producers is to use the best possible breed or mix of breeds and to select the best bulls available within those breeds. To increase the production of red meat in Turkey crosbreed with beef breeds is recommended. Breed characteristics must also be matched to the environment. As for example, the late maturing large European breeds such as Charolais and Simmental, have been shown to produce higher growth rates than the traditional smaller early maturing breeds such as Shorthorn, Angus and Hereford. High growth rate in a temperate environment however is often related to high birth weight in many British and European breed animals which in turn may result in a higher incidence of dystocia and a decrease in reproductive efficiency. These temperate breeds also have higher growth rates than the tropically adapted breeds under very favourable environments of low parasite levels and abundant good quality feed. The biggest problems of the small scale Turkish dairy farmers is to keep offspring productive and low survival rate of their offspring. Adana metropolitan municipality has implemented a project to solve these problems of rural area cattle keepers due to its contribution to family income and livestock breeding. In this project, Angus, Piedmontese and Simmental breeds have been used for artificial insemination of Holstein and different levels of cows. Calf starter feed was also provided for success in the care of calves born within the scope of the project. The aim of this study is to present the results of the survival and groth performance results of the crossbreds calves of Angus, Piedmontese and Simmental breeds at Turkish rural dairy farm levels .Sığır eti üreticilerinin temel hedefi yüksek performans elde etmektir. Özellikle besicilikte besiye uygun hayvan temini çok önemlidir. Üreticiler için en iyi hayvanı sürekli olareak temi edebilmek daha da önemlidir. Türkiye'de kırmızı et üretimini arttırmak için melezleme çalışmaları önerilmektedir. Ancak seçilen ırkların bölge koşullarına uyumlu olması gerekir. Örneğin, Charolais ve Simmental gibi büyük Avrupa ırklarının, Shorthorn, Angus ve Hereford gibi küçük ırklarından daha yüksek büyüme gösterdiği görülmüştür. Ancak, ılıman bir ortamda yüksek büyüme oranı çoğu zaman İngiliz ve Avrupa orijinli hayvanlarda yüksek doğum ağırlığı ile ilgili üreme verimliliğinde düşüşe neden olabilir. Kültür ırkları ayrıca parazit problemi olmayan yerlerde ve bol miktarda kaliteli yemin bulunduğu ortamlarda yüksek canlı ağırlık artışı gösterebilirler. Küçük ölçekli çiftçilerinin en büyük problemi, yavru ölümleridir. Adana'da büyükşehir belediyesi, kırsal alan sığır yetiştiricilerinin bu sorunlarını çözmek için proje yürütmüş ve bu projede, Angus, Piedmontese ve Simmental ırkları ile halk elindeki ineklerin yapay tohumlama ile melezleme çalışması yürütülmüştür. Proje kapsamında doğan buzağıların bakımında kullanılmak ve yaşam gücünü desteklemek amacıyla buzağı başlangıç yemi desteği de verilmiştir. Bu çalışma ile uygulama sonuçları karşılaştırmalı olarak değerlendirilerek sunulması amaçlanmıştır

Performance of different criteria sets for inflammatory back pain in patients with axial spondyloarthritis with and without radiographic sacroiliitis

It is important to recognize inflammatory back pain (IBP) for an early diagnosis of ankylosing spondylitis (AS). Assessment of Spondyloarthritis International Society (ASAS) has recently published new criteria set for diagnosing IBP. In the present study, we evaluated the performance of the new ASAS IBP criteria and to compare the performance of IBP criteria sets in axial spondyloarthritis (axSpA) patients with and without radiographic sacroiliitis. The study sample included a total of 274 patients with a diagnosis of axSpA and 50 patients with a diagnosis of chronic (>3 months) mechanical back pain (MBP). A face-to-face interview by using a standardized questionnaire addressing all the components of IBP was performed. Data about HLA-B27 status and C-reactive protein levels were obtained from the patients’ charts. There were significantly more male patients (P 30 min (Calin 30), the specificity improved (72.9 %), but at a price of loss in sensitivity (82.4 %). In this study, new ASAS criteria for IBP performed almost as good as but not better than the existing criteria sets. Performances of the criteria sets were quite comparable in the differentiation of IBP from MBP in patients with and without radiographic sacroiliitis. © 2014, Clinical Rheumatology