Diagnostic delay in psoriatic arthritis: insights from a nationwide multicenter study.

This study aimed to investigate the duration of diagnostic delay in patients with psoriatic arthritis (PsA) and identify potential contributing factors using a comprehensive, population-based approach. Data were obtained from the Turkish League Against Rheumatism (TLAR)-Network, involving patients who met the CASPAR criteria. Diagnostic delay was defined as time interval from symptom onset to PsA diagnosis, categorized as ≤ 2 years and > 2 years. Temporal trends were assessed by grouping patients based on the year of diagnosis. Various factors including demographics, clinical characteristics, disease activity, quality of life, physical function, disability, fatigue, and well-being were examined. Logistic regression models were used to identify factors associated with diagnostic delay. Among 1,134 PsA patients, mean diagnostic delay was 35.1 months (median: 12). Approximately 39.15% were diagnosed within 3 months, and 67.02% were diagnosed within 24 months. Patients experiencing longer delays had higher scores in Psoriatic Arthritis Quality of Life Questionnaire (PsAQoL), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), patient's global assessment (PtGA) and physician's global assessment (PhGA). Diagnostic delay has decreased over time, with median delay falling from 60 to 24 months throughout pre-2010 and 2015-2019 terms. Several factors were identified as significant contributors to delayed diagnosis, including lower levels of education (OR = 2.63), arthritis symptoms preceding skin manifestations (OR = 1.72), low back pain at first visit (OR = 1.60), symptom onset age (OR = 0.96), and psoriasis subtype (OR = 0.25). Timely diagnosis of PsA is crucial for effective management and improved outcomes. Despite recent improvements, about one-third of PsA patients still experience delays exceeding 2 years. By identifying influential factors such as education level, arthritis symptoms preceding skin manifestations, initial visit symptoms, age of symptom onset, and psoriasis subtype, healthcare practitioners may create specific techniques to help in early detection and intervention.

Novel barium-doped-baghdadite incorporated PHBV-PCL composite fibrous scaffolds for bone tissue engineering.

Bioceramic/polymer composites have dragged a lot of attention for treating hard tissue damage in recent years. In this study, we synthesized barium-doped baghdadite (Ba-BAG), as a novel bioceramic, and later developed fibrous composite poly (hydroxybutyrate) co (hydroxyvalerate)- polycaprolactone (PHBV-PCL) scaffolds containing different amounts of baghdadite (BAG) and Ba-BAG, intended to be used in bone regeneration. Our results demonstrated that BAG and Ba-doped BAG powders were synthesized successfully using the sol-gel method and their microstructural, physicochemical, and cytotoxical properties results were evaluated. In the following, PHBV/PCL composite scaffolds containing different amounts of BAG and Ba-BAG (1, 3, and 5 wt%) were produced by the wet electrospinning method. The porosity of scaffolds decreased from 78% to 72% in Ba-BAG-incorporated PHBV/PCL scaffolds. The compressive strength of the scaffolds was between 4.69 and 9.28 kPa, which was increased to their maximum values in the scaffolds with Ba-BAG. The presence of BAG and Ba-BAG in the polymer scaffolds resulted in increasing bioactivity, and it was introduced as a suitable way to control the degradation rate of scaffolds. The presence of the BAG component was a major reason for higher cell proliferation in reinforced PHBV/PCL polymeric scaffolds, while Ba existence played its influential role in the higher osteogenic activity of cells on Ba-BAG incorporated PHBV/PCL scaffolds. Thus, the incorporation of Ba-BAG bioceramic materials into the structure of polymeric PHBV/PCL scaffolds promoted their various properties, and allow these scaffolds to be used as promising candidates in bone tissue engineering applications.

Beyond expectations: disease duration and psychological burden in psoriatic arthritis.

This study aims to investigate the relationship between disease duration and psychological burden in PsA and to identify the risk factors associated with psychological distress. Patients with PsA who met CASPAR classification criteria enrolled by Turkish League Against Rheumatism (TLAR)-Network. Patients were categorized into three groups based on disease duration: early stage (< 5 years), middle stage (≥ 5, < 10 years), and late stage (≥ 10 years). All patients underwent clinical and laboratory assessment using standardized protocol and case report forms. The associations between psychological variables and clinical parameters were assessed by a multivariate analysis. Of the 1113 patients with PsA (63.9% female), 564 (%50.7) had high risk for depression and 263 (%23.6) for anxiety. The risk of psychological burden was similar across all PsA groups, and patients with a higher risk of depression and anxiety also experienced greater disease activity, poorer quality of life, and physical disability. Multivariate logistic regression revealed that female gender (OR = 1.52), PsAQoL (OR = 1.13), HAQ (OR = 1.99), FiRST score (OR = 1.14), unemployment/retired (OR = 1.48) and PASI head score (OR = 1.41) were factors that influenced the risk of depression, whereas the current or past enthesitis (OR = 1.45), PsAQoL (OR = 1.19), and FiRST score (OR = 1.26) were factors that influenced the risk of anxiety. PsA patients can experience a comparable level of psychological burden throughout the course of their disease. Several socio-demographic and disease-related factors may contribute to mental disorders in PsA. In the present era of personalized treatment for PsA, evaluating psychiatric distress can guide tailored interventions that improve overall well-being and reduce disease burden.

Injectable methacrylated gelatin/thiolated pectin hydrogels carrying melatonin/tideglusib-loaded core/shell PMMA/silk fibroin electrospun fibers for vital pulp regeneration.

Use of injectable hydrogels attract attention in the regeneration of dental pulp due to their ability to fill non-uniform voids such as pulp cavities. Here, gelatin methacrylate/thiolated pectin hydrogels (GelMA/PecTH) carrying electrospun core/shell fibers of melatonin (Mel)-polymethylmethacrylate (PMMA)/Tideglusib (Td)-silk fibroin (SF) were designed as an injectable hydrogel for vital pulp regeneration, through prolonged release of Td and Mel to induce proliferation and odontoblastic differentiation of dental pulp stem cells (DPSC). H NMR and FTIR confirmed methacrylation of Gel and thiolation of Pec. Addition of PMMA/SF increased degradation and water retention capacities of GelMA/PecTH. Rheological analyses and syringe tests proved the injectability of the hydrogel systems. Release studies indicated that Td and Mel were released from the fibers inside the hydrogels sequentially due to their specific locations. This release pattern from the hydrogels resulted in DPSC proliferation and odontogenic differentiation in vitro. Gene expression studies showed that the upregulation of DMP1, DSPP, and Axin-2 genes was promoted by GelMA/PecTH carrying PMMA/SF loaded with Mel (50 µg/mL) and Td (200 nM), respectively. Our results suggest that this hydrogel system holds promise for use in the regeneration of pulp tissue.

The assessment of neuropathic pain in patients with prediabetes.

AIMS: Neuropathic pain is associated with several clinical conditions, including anxiety, depression, sleep disorders, and decreased quality of life; however, less evaluated in prediabetes. This study aims to assess neuropathic pain through validated diagnostic tools in prediabetes. METHODS: One hundred and seventy-two patients with prediabetes and 170 controls were included in this cross-sectional study. The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale and Douleur Neuropathique 4 Questions (DN4) were used to evaluate neuropathic pain. The Visual Analog Scale (VAS) was used to estimate pain intensity. RESULTS: Twenty-three (13.4%) and 12 (7%) patients with prediabetes were diagnosed with neuropathic pain using DN4 and LANSS questionnaires, respectively. Neuropathic pain rates of the patients were higher than controls with two pain scales (p < 0.001). VAS scores were higher in prediabetes group than in controls (p = 0.021). LANSS, DN4, and VAS scores were positively correlated with HbA1c level (r = 0.184, p = 0.016; r = 0.180, p = 0.018; r = 0.188, p = 0.014, respectively). LANNS and DN4 scores were higher in female patients than in males (p < 0.001). CONCLUSIONS: Neuropathic pain was increased in prediabetes by DN4 and LANNS questionnaires. An appropriate diagnosis of neuropathic pain in prediabetes may prevent patients from different pain-related clinical conditions.

The impact of nail psoriasis on disease activity, quality of life, and clinical variables in patients with psoriatic arthritis: A cross-sectional multicenter study.

AIM: Nail involvement is common in psoriatic arthritis. This study assesses clinical characteristics, nail psoriasis prevalence, and impact of nail psoriasis on disease activity in patients with psoriatic arthritis (PsA). METHOD: This cross-sectional multicenter study was conducted by the Turkish League Against Rheumatism using PsA patients recruited from 25 centers. Demographic and clinical characteristics of PsA patients, such as disease activity measures, quality of life, and nail involvement findings were assessed during routine follow-up examinations. Patients were divided into two groups according to the presence or absence of nail psoriasis and compared using the χ2 test or Fisher exact test for categorical variables and the t-test or Mann-Whitney U test for continuous variables. RESULTS: In 1122 individuals with PsA, 645 (57.5%) displayed nail psoriasis. The most frequent features of fingernails were ridges (38%), followed by pitting (21%) and onycholysis (19%). More females were present in both groups (with and without nail psoriasis; 64% vs 67%, P < 0.282). Patients with nail psoriasis were older, indicated more pain and fatigue, experienced greater swelling, tender joint counts, and skin disease severity, and had a higher disease activity score compared with those without nail psoriasis (all P < 0.05). CONCLUSION: We demonstrate an increased prevalence of nail psoriasis observed in patients with psoriatic arthritis. Patients with nail involvement experience increased disease activity, lower quality of life, and diminished mental and physical status compared with those without nail involvement.

Isolation and characterization of Brochothrix phage ADU4.

B. thermosphacta is a psychrotrophic bacterium that often forms the predominant part of the spoilage microflora of aerobically and anaerobically stored meats. Bacteriophages are natural enemies of bacteria and their potential for use in environmentally friendly biocontrol of specific pathogens in food is being intensively studied. In this study, we reported the isolation and characterization of the newly isolated lytic Brochothrix phage ADU4, which is capable of infecting the B. thermosphacta bacterium. For the characterization of Brochothrix phage ADU4; host range, multiplicity of infection values (MOI), phage growth parameters (latent period and burst size), stability at various temperatures and pH, reduction growth of bacteria, effect on biofilm, and molecular characterization were investigated. The spot-test analysis showed positivity with B. thermosphacta strains, while no infection was observed in any other species and genera of bacteria tested. The optimal MOI value of the phage was determined as 0.1. The phage latent period and burst sizes were 40-50 min and 311 PFU/ml per infected host cell, respectively by one-step growth curve analysis. Brochothrix phage ADU4 reduced bacteria immediately after infection, which is shown by optical density (OD) measurement and colony counting (<10 CFU/ml) for 3 days. The degradation of B. thermosphacta in biofilm by Brochothrix phage ADU4 was analyzed and it was found that high titer phage breakdown the existing biofilm and also persistently inhibited biofilm formation. Brochothrix phage ADU4 genome was found to be 127,819 bp, and GC content 41.65%. The genome contains 217 putative open reading frames (ORFs), 4 tRNAs, and additionally, no known virulence and antibiotic resistance genes (AMR) were identified. Brochothrix phage ADU4 showed a high identity (96.09%) to the A9 phage that belongs to the Herelleviridae family. Nevertheless, the assembly module and its around appeared less conserved, and some DNA fragments in Brochothrix phage ADU4 genome were not found in A9 genome and vice versa. A9 contains TnpB, a transposase accessory protein involved in lysogenicity which is absent in Brochothrix phage ADU4. In contrary Brochothrix phage ADU4 had auxiliary metabolic genes (AMG) mostly carried by lytic phages. All these results showed that the Brochothrix phage ADU4 has excellent properties such as strong antibacterial activity, short latent period, high burst size, stability in different conditions, inhibition of biofilms, and absence of virulence and AMR genes. Based on all these features, this newly isolated phage is promising to control B. thermosphacta contamination in meat and meat products, and has the potential to be used alone or in combination with phage cocktails.

Pullulan hydrogel-immobilized bacterial cellulose membranes with dual-release of vitamin C and E for wound dressing applications.

Vitamin C&E (VtC&VtE)-loaded bilayer wound dressings were prepared using bacterial cellulose (BC) synthesized by Acetobacter species and pullulan (PUL). VtC-containing PUL hydrogels (100 µg/mL) were immobilized onto BC by crosslinking. BC/PUL-VtC was loaded with VtE (100 µM in ethanol) by immersion for 2 h. No delamination between the layers was observed via SEM. Despite the porous inner PUL side, the outer BC side exhibited nanofibrous morphology serving as barriers to prevent microorganism invasion. Equilibrium water content of BC/PUL was above 85 % due to the hydrogel characteristics of PUL side, suitable to absorb exudate in wound bed. PUL layer lost >90 % of its weight in simulated wound fluid and > 99 % in lysozyme solution within 14 days, mediating co-release of VtC&VtE. Thin BC side possessed adequate strength (⁓22 MPa) and strain (>30 %) to endure against tensile stress generated by bending on wound surface without rupture, whereas thick PUL side was flexible (>70 % strain) to fit into wound bed under compressive stress without causing harm. In vitro studies using L929 fibroblasts elucidated PUL side was anti-adhesive and removable. Synergistic effect of VtC&VtE on antioxidant activity, wound closure, and collagen synthesis was observed. Thus, BC/PUL-VtC/VtE hold promise as cheap and eco-friendly temporary wound dressing.

Decellularized adipose tissue matrix-coated and simvastatin-loaded hydroxyapatite microspheres for bone regeneration.

Simvastatin (SIM)-loaded and human decellularized adipose tissue (DAT)-coated porous hydroxyapatite (HAp) microspheres were developed for the first time to investigate their potential on bone regeneration. Microspheres were loaded with SIM and then coated with DAT for modifying SIM release and improving their biological response. HAp microspheres were prepared by water-in-oil emulsion method using camphene (C10 H16 ) as porogen followed by camphene removal by freeze-drying and sintering at 1200°C for 3 h. Sintered HAp microspheres with an average particle size of ~400 µm were porous and spherical in shape. Microspheres were incubated with 1, 2.5, and 5 mg/ml SIM stock solutions for drug loading, and drug loading was determined as 7.5 ± 0.79, 20.41 ± 1.93, and 46.26 ± 0.29 µg SIM/mg microspheres, respectively. SIM loading increased with the increase of the initial SIM loading amount. Faster SIM release was observed in DAT-coated microspheres compared to bare counterparts. Higher SaoS-2 cell attachment and proliferation were observed on DAT-coated microspheres. Significantly higher alkaline phosphatase activity of SaoS-2 cells was observed on DAT-coated microspheres containing 0.01 mg/ml SIM than all other groups (p < 0.01). DAT-coated microspheres loaded with SIM at low doses hold promise for bone tissue engineering applications.

Natural origin bilayer pullulan-PHBV scaffold for wound healing applications.

Skin tissue loss that occurs by injury and diseases can turn into chronic wounds as a result of complications alongside infection. Chronic wounds fail to heal by themselves and need advanced treatments like engineered wound dressings and regenerative scaffolds. In this study, a novel, natural origin, bilayer electrospun scaffold was produced from pullulan (PUL) and poly(hydroxybutyrate-co-hydroxyvalerate) (PHBV) biopolymers. PHBV production by Cupriavidus necator bacterial strain was optimized and produced polymer was characterized. Characteristic peaks and bands of PHBV were observed by H-NMR and FTIR analyses. Valerate mol percent of produced PHBV copolymer was determined by H-NMR. Average molecular weight of the polymer was determined by SLS technique and crystallinity of PHBV was calculated from DSC curve. Bilayer scaffold was produced by electrospinning of hydrophilic PUL fibrous membrane onto wet-electrospun hydrophobic PHBV 3D fibrous mat. Bilayer scaffold was designed to involve regenerative and barrier fibrous layers. Nano fibrous PUL membrane with smaller pore size was efficient as a barrier against bacterial transmission while enabling optimum oxygen and water vapor transmission. Water retention and degradation properties were found to be optimum for a skin tissue scaffold. In vitro studies showed that PUL membrane sustained L929 cell proliferation while preventing cells from migrating inside the barrier phase while PHBV layer supported cell viability, proliferation, and migration, creating a regenerative 3D structure. Results showed that, novel natural origin PUL/PHBV bilayer scaffold is a promising candidate for wound healing applications.

Best Practice Recommendations for Geriatric Dysphagia Management with 5 Ws and 1H.

BACKGROUND: Dysphagia is a geriatric syndrome. Changes in the whole body that occur with aging also affect swallowing functions and cause presbyphagia. This condition may progress to oropharyngeal and/or esophageal dysphagia in the presence of secondary causes that increase in incidence with aging. However, no study has been published that provides recommendations for use in clinical practice that addresses in detail all aspects of the management of dysphagia in geriatric individuals. This study aimed to answer almost all potential questions and problems in the management of geriatric dysphagia in clinical practice. METHODS: A multidisciplinary team created this recommendation guide using the seven-step and three-round modified Delphi method via e-mail. The study included 39 experts from 29 centers in 14 cities. RESULTS: Based on the 5W and 1H method, we developed 216 detailed recommendations for older adults from the perspective of different disciplines dealing with older people. CONCLUSION: This consensus-based recommendation is a useful guide to address practical clinical questions in the diagnosis, rehabilitation, and follow-up for the management of geriatric dysphagia and also contains detailed commentary on these issues.

Xanthan-gelatin and xanthan-gelatin-keratin wound dressings for local delivery of Vitamin C.

Recently, functional dressings that can protect the wound area from dehydration and bacterial infection and support healing have gained importance in place of passive dressings. This study aimed to develop temporary and regenerative xanthan/gelatin (XGH) and keratin/xanthan/gelatin hydrogels (KXGHs) that have high absorption capacity and applicability as a wound dressing that can provide local delivery of Vitamin C (VC). Firstly, xanthan/gelatin hydrogels were produced by crosslinking with different glycerol concentrations and characterized to determine the hydrogel composition. According to their weight ratios, xanthan, gelatin, and glycerol hydrogels are named. If their weight ratio is 1:1:2 (w/w/w), the group name is selected as X1:GEL1:GLY2. X1:GEL1:GLY2 hydrogel was selected for biocompatibility, mechanical property, water vapor transmission rate (WVTR), and porosity. The addition of keratin to X1:GEL1:GLY2 improved L929 fibroblasts viability and increased protein release. Water vapor transmission of XGHs and KXGHs was between 3059.09 ± 126 and 4523 ± 133 g m-2 d-1; therefore, they can be suitable for granulating, low to moderate exudate wounds. XGH and KXGHs loaded with VC had higher water uptake, making it more convenient for exudate wounds. VC was released for 100 h, and VC containing XGHs and KXGHs increased the collagen synthesis of L929 fibroblasts. All of the hydrogels (XGH, KXGH, and VC-KXGHs) inhibited the bacteria transmission. In conclusion, our results suggest that VC-XGH and VC-KXGH can be candidates for temporary wound dressing materials for skin wounds.

Evaluation of the physical and emotional effects of the COVID-19 pandemic on patients with fibromyalgia and chronic low back pain: A multicenter cross-sectional controlled study.

Objectives: This study aimed to investigate the physical and emotional effects of the coronavirus disease 2019 pandemic in patients with fibromyalgia syndrome (FMS) and chronic low back pain (CLBP) patients. Patients and methods: The cross-sectional controlled study was performed with 1,360 participants (332 males, 1,028 females; mean age: 42.3±12.5 years; range, 18 to 65 years) between September 2020 and February 2021. The participants were evaluated in three groups: the FMS group (n=465), the CLBP group (n=455), and the healthy control group (n=440). Physical activity, pain levels, and general health status before and during the pandemic were evaluated in all participants. Stress levels were analyzed with the perceived stress scale (PSS) in all groups, and disease activity was analyzed with the fibromyalgia impact questionnaire (FIQ) in patients with FMS. Results: Patients with FMS had worsened general health status and pain levels during the pandemic compared to the other groups (p<0.01). The FMS group showed significantly higher PSS scores than those in other groups (p<0.01). There was a weak-positive correlation between FIQ and PSS parameters in patients with FMS (p<0.05, r=0.385). Conclusion: The general health status, pain, and stress levels of the patients with FMS and CLBP tended to worsen during the pandemic. This high-stress level appeared to affect disease activity in patients with FMS.

Inconsistencies of the Disease Activity Assessment Tools for Psoriatic Arthritis: Challenges to Rheumatologists.

OBJECTIVE: Currently, concerning the evaluation of psoriatic arthritis (PsA), there is no agreement on a standardized composite index for disease activity that includes all relevant domains. The present study sought to assess the rates of remission (REM)/low disease activity (LDA) and disease states [minimal disease activity (MDA), very low disease activity (VLDA)] as defined by diverse activity scales (DAPSA, DAS28-ESR) in an attempt to display discrepancies across these assessment tools for peripheral PsA. METHODS: The study involved 758 patients (496 females, 262 males; mean age 47,1 years) with peripheral PsA who were registered to the Turkish League Against Rheumatism (TLAR) Network. The patients were assessed using the DAS28-ESR, DAPSA, MDA, and VLDA. The overall yield of each scale was assessed in identifying REM and LDA. The presence or absence of swollen joints was separately analysed. RESULTS: The median disease duration was 4 years (range 0-44 years). According to DAPSA and DAS28-ESR, REM was achieved in 6.9% and 19.5% of the patients, respectively. The rates of MDA and VLDA were 16% and 2.9%, respectively. Despite the absence of swollen joints, a significant portion of patients were not considered to be in REM (296 (39.1%) patients with DAS28-ESR, 364 (48%) with DAPSA, and 394 (52%) with VLDA). CONCLUSION: Patients with peripheral PsA may be assigned to diverse disease activity levels when assessed with the DAS28-ESR, DAPSA, MDA and VLDA, which would inevitably have clinical implications. In patients with PsA a holistic approach seems to be necessary which includes other domains apart from joint involvement, such as skin involvement, enthesitis, spinal involvement, and patient-reported outcomes.

The relationship between kinesiophobia and health-related quality of life in patients with rheumatoid arthritis: A controlled cross-sectional study.

OBJECTIVES: To evaluate the kinesiophobia and kinesiophobia-related factors in patients with rheumatoid arthritis (RA) and provide a better perspective on the relationship between kinesiophobia and patients' health-related quality of life (HRQoL). METHODS: A total of 88 patients (67 females, 21 males) with RA and 93 healthy volunteers (67 females, 26 males) were included in the study between March 2020 and July 2020. Kinesiophobia was evaluated using the Tampa Scale of Kinesiophobia (TSK) and HRQoL was evaluated using the 36-item Short-Form Health Survey (SF-36). The Fatigue Severity Scale (FSS), Beck Depression Inventory (BDI), Health Assessment Questionnaire Disability Index (HAQ-DI), International Physical Activity Questionnaire (IPAQ) (Short Form) were completed by all participants. RESULTS: The median age was 52.0 (IQR, 45.0-58.0) years in the RA group and 50.0 (IQR, 41.5-56.0) years in the control group. Age and sex were not significantly different between the groups. The median TSK score was 45.0 (IQR, 39.0-49.75) in the RA group, 39.0 (IQR, 37.0-43.0) in the control group (P<0.001). The median FSS, BDI, and HAQ-DI scores were higher and the median HRQoL domains were lower in the RA group than in the control group (P<0.05). Multivariate linear regression analysis including age, sex, education level, body mass index (BMI), morning stiffness duration, Disease Activity Score in 28 joints, FSS, BDI, visual analog scale and IPAQ scores variables showed that FSS scores (B=1.07, P<0.05), BDI scores (B=0.24, P<0.05), and BMI (B=0.22, P<0.05) were independent variables for kinesiophobia in patients with RA (R2=0.32). TSK was a predictive variable for HAQ-DI (B=0.03, P<0.001), the physical functioning domain of the HRQoL (B=-1.18, P<0.001), the bodily pain domain of the HRQoL (B=-0.78, P<0.05), respectively. CONCLUSION: Physicians should have awareness of kinesiophobia in patients with RA. Educating patients about kinesiophobia, developing strategies for avoiding kinesiophobia, and specific treatment strategies with a multidisciplinary approach may improve HRQoL and disability.

Impact of obesity on quality of life, psychological status, and disease activity in psoriatic arthritis: a multi­center study.

This article aims to evaluate the possible effect of obesity on quality of life, psychological status, and other clinical variables in Psoriatic arthritis (PsA). PsA patients have been recruited by the Turkish League Against Rheumatism-Network from various centers in Turkey in this cross-sectional study. Patients with a body mass index (BMI) ≥ of 30 kg/m2 were considered obese. Differences among patients with regard to obesity status were assessed with health-related quality of life measures (PsA Quality of Life Questionnaire [PsAQoL]), psychological status (Hospital Anxiety and Depression Scale [HADS]), and disease activity parameters (the Disease Activity index for PSoriatic Arthritis [DAPSA], Disease Activity Score 28-C-reactive protein [DAS28-CRP], Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Psoriasis Area and Severity Index [PASI]), physical functions (Ankylosing Spondylitis Functional Index [BASFI], Health Assessment Questionnaire [HAQ], and Health Assessment Questionnaire for the spondyloarthropathies [HAQ-S]). Pain was assessed using visual analog scale of pain (VAS-P), and fatigue was evaluated using visual analog scale of fatigue (VAS-F) and Functional Assessment of Chronic Illness Therapy (FACIT). A total of 1033 patients with PsA, 650 (62.9%) non-obese and 383 (37.1%) obese were included in the study. The PsAQoL, HADS-Anxiety, HADS-Depression, DAPSA, DAS28-CRP, BASDAI, BASFI, HAQ and HAQ-S scores of the obese group were higher than the non-obese group (p < 0.05). VAS-P and PASI scores were similar between group of patients with and without obesity. Obese patients had higher median scores of VAS-F and FACIT than non-obese patients (p < 0.05). Linear regression analysis showed that BMI affects the quality of life, depression, and disease activity. Consequently, obesity has significant associations with higher disease activity, lower QoL, risk of anxiety, depression, and fatigue. Therefore, obesity should also be taken into account in the management of PsA patients.

Best Practice Recommendations for Stroke Patients with Dysphagia: A Delphi-Based Consensus Study of Experts in Turkey-Part I: Management, Diagnosis, and Follow-up.

Dysphagia is one of the most common and important complications of stroke. It is an independent marker of poor outcome after acute stroke and may become chronic after the acute period and continues to affect all aspects of the patient's life. Patients with stroke may encounter any of the medical branches in the emergency room or outpatient clinic, and as in our country, there may not be specialists specific for dysphagia, such as speech-language pathologists (SLP), in every hospital. This study aimed to raise awareness and create a common opinion of medical specialists for stroke patients with dysphagia. This recommendation paper has been written by a multidisciplinary team and offers 45 recommendations for stroke patients with dysphagia. It was created using the eight-step Delphi round via e-mail. This study is mostly specific to Turkey. However, since it contains detailed recommendations from the perspective of various disciplines associated with stroke, this consensus-based recommendation paper is not only a useful guide to address clinical questions in practice for the clinical management of dysphagia in terms of management, diagnosis, and follow-up, but also includes detailed comments for these topics.

Cytogenetic profile of adult AML patients in Turkey: a single center study with comprehensive comparison with literature.

Background: Cytogenetic findings are important prognostic factors in acute myeloid leukemia. Large systematic data about chromosomal characteristics of Turkish AML patients have not been reported to date. Objectives: The karyotypic profiles of 157 adult AML patients were evaluated retrospectively and compared with other reports from different populations. Methods: Cytogenetics analyses were performed on bone marrow samples using G-banding. Patients were categorized according to their cytogenetic results into four groups with the addition of a normal karyotyped group to the favorable, intermediate and adverse groups of European Leukemia Network. Results: Cytogenetic analyses were carried out successfully in 138 patients (88%). Abnormal karyotypes were found in 79 (57.2%) patients of which 13 (9.4%) were in favorable, 37 (26.8%) in intermediate and 29 (21%) in adverse groups. t(8;21) (5%) was the most common favorable abnormality while monosomal karyotypes (15.9%) in adverse group. Conclusion: This single center study is the most comprehensive study about the cytogenetic profile of acute myeloid leukemia in Turkey with comparison of other population-based studies. While there were similarities and differences with different publications, our results did not show a marked tendency to the findings of any specific geographic region.

Investigation of the effect of ghrelin on bone fracture healing in rats.

Ghrelin is known to have effects on proliferation and differentiation of osteoblasts and improvement of bone mineral density in rats. However, no experimental research on ghrelin's effects on fracture healing has been reported. In this context, the effect of ghrelin on the union of femoral shaft fractures was examined in this study by evaluating whether ghrelin will directly contribute to fracture healing. Forty male Wistar-Albino rats were divided into two groups as control and experimental (ghrelin treated) and standard closed shaft fractures were created in the left femurs of all rats. Daily ghrelin injections were applied to the experimental groups and equal numbers of rats were killed after 14 and 28 days following fracture formation. Tissue samples were examined with radiological, biomechanical, biochemical and histological analyses. Densitometry study showed that bone mineral density was improved after 28 days of ghrelin treatment compared to control. On histological examination, at the end of the 14 and 28 days of recovery, significant union was observed in the ghrelin-treated group. The ghrelin-treated group had higher breaking strength and stiffness at the end of 28 days of recovery. Biochemically, ALP levels were found to be higher in the ghrelin-treated group at the end of 28 days of recovery. Results showed that ghrelin directly contributes to fracture healing and it is promising to consider the effect of ghrelin on fracture healing in human studies with pharmacological applications.