Management of life-threatening flecainide overdose: a case report of an infant.

Flecainide overdose is associated with an approximately 10% mortality rate. The drug's slow rate of elimination and high oral bioavailability make successful management extremely challenging. I present the management of a life-threatening flecainide overdose of an infant who had a protracted course due to the exposure to the drug in both the fetal and neonatal periods.

Translation and validation of the Turkish version of the Ankylosing Spondylitis Quality of Life (ASQOL) questionnaire.

The Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire is a disease-specific measure of needs-based quality of life developed in the UK and the Netherlands. This study describes translation, validation, and reliability of the scale into Turkish population. The ASQoL was translated into Turkish using the dual-panel process. Content validity was assessed via cognitive debriefing interviews with ankylosing spondylitis (AS) patients. Patients with AS according to modified New York criteria were recruited into the study from 12 hospitals of all part of Turkey. Psychometric and scaling properties were assessed via a two administration survey involving the ASQoL, the Nottingham Health Profile (NHP), Bath AS Functional Index (BASFI), and Bath AS Disease Activity Index (BASDAI). Classical psychometrics assessed reliability, convergent validity (correlation of ASQoL with NHP, BASFI, and BASDAI) and discriminative validity (correlation of ASQoL with perceived AS-severity and general health). Cognitive debriefing showed the new Turkish ASQoL to be clear, relevant, and comprehensive. Completed survey questionnaires were received from 277 AS patients (80% Male, mean age 42.2/SD 11.6, mean AS duration 9.4 years/SD 9.4). Test-retest reliability was excellent (0.96), indicating low random measurement error for the scale. Correlations of ASQoL with NHP sections were low to moderate (NHP Sleep 0.34; NHP Emotional Reactions 0.83) suggesting the measures assess related but distinct constructs. The measure was able to discriminate between patients based on their perceived disease severity (p < 0.0001) and self-reported general health (p < 0.0001). The Turkish version of ASQoL has good reliability and validity properties. It is practical and useful scale to assess the quality of life in AS patients in Turkish population.

EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis.

OBJECTIVE: To develop evidence-based recommendations for the diagnosis of knee osteoarthritis (OA). METHODS: The multidisciplinary guideline development group, representing 12 European countries, generated 10 key propositions regarding diagnosis using a Delphi consensus approach. For each recommendation, research evidence was searched systematically. Whenever possible, the sensitivity, specificity and likelihood ratio were calculated for individual diagnostic indicators and a diagnostic ladder was developed using Bayes' method. Secondary analyses were undertaken to test directly the recommendations using multiple predictive models in two populations from the UK and the Netherlands. Strength of recommendation was assessed by the EULAR visual analogue scale. RESULTS: Recommendations covered the definition of knee OA and its risk factors, subsets, typical symptoms and signs, the use of imaging and laboratory tests and differential diagnosis. Three symptoms (persistent knee pain, limited morning stiffness and reduced function) and three signs (crepitus, restricted movement and bony enlargement) appeared to be the most useful. Assuming a 12.5% background prevalence of knee OA in adults aged > or =45 years, the estimated probability of having radiographic knee OA increased with increasing number of positive features, to 99% when all six symptoms and signs were present. The performance of the recommendations in the study populations varied according to the definition of knee OA, background risk and number of tests applied. CONCLUSION: 10 key recommendations for diagnosis of knee OA were developed using both research evidence and expert consensus. Although there is no agreed reference standard, thorough clinical assessment alone can provide a confident rule-in diagnosis.

Prevalence of rheumatoid arthritis in Antalya, Turkey.

The aim of this study was to evaluate the prevalence of rheumatoid arthritis (RA) in Antalya, Turkey. A cross-sectional study was performed face-to-face using a structured interview. Subjects were asked whether they had arthritis at present or previously. Subjects suspected of having RA were invited to the hospital for physical examination and laboratory investigations. Diagnosis of RA was confirmed if the patient fulfilled 1987 American College of Rheumatology (ACR) criteria for RA. A total of 3173 subjects were interviewed. The diagnosis of RA was established in 12 subjects. The prevalence of RA was determined as 0.38% [95% confidence interval (CI): 0.16-0.59]. The mean age was 49.92+/-11.56 years in subjects with RA and greater than that of other subjects (p<0.001). Of 12 subjects with RA, 9 had previously been diagnosed with the disease. Rheumatoid factor was detected in the sera of eight subjects. RA is less frequent in Turkey than in Northern Europe. Different genetic and environmental factors may have a role in this result.

The prevalence of symptomatic knee and distal interphalangeal joint osteoarthritis in the urban population of Antalya, Turkey.

The aim of this cross-sectional study was to estimate the prevalence and risk factors of symptomatic knee and distal interphalangeal (DIP) joint osteoarthritis (OA) in the elderly (> or =50 years of age) urban population of Antalya, Turkey. According to the 1997 national census, Antalya's population was 508,840. By random cluster sampling, 655 individuals aged 50 years or more were interviewed face-to-face and subjected to structured interviews regarding knee pain, worsening pain on exertion, and the gelling phenomenon. They were also asked about performing namaz (a fundamental act of worship in Islam performed five times a day), smoking, type of residence, type of toilet, work style, and duration of walking per day. They were also questioned about swelling in DIP joints. In the case of suspicion of knee OA, the individuals were invited to the hospital for further evaluation by physical examination and direct roentgenogram. The diagnosis of knee OA was based on clinical or clinical and radiographic findings. The prevalence of symptomatic knee OA was determined as 14.8% in the population aged 50 years or over. Advanced age, female sex, namaz, and type of residence were found to be associated with knee OA. The rate of symptomatic knee OA was significantly lower in smokers and those walking more than 2 h per day. Female sex was also strongly associated with OA DIP joints. OA of DIP joints was found significantly associated with symptomatic knee OA. The latter is a major health problem in the elderly population, especially in about one fourth of women aged 50 years or over. These data suggest that advanced age, female sex, and type of residence are risk factors.

The association of milk consumption with the occurrence of symptomatic knee osteoarthritis.

OBJECTIVE: To evaluate the association of nutritional factors with symptomatic knee OA. METHODS: This cross-sectional study was performed face-to-face using a structured interview. Individuals who had a diagnosis of symptomatic knee OA and were aged 50 years or over were included in this study. The frequency of consumption of dairy products, meat/poultry, fish, cereals, vegetables, tea and coffee were also determined. The diagnosis of knee OA was made clinically or clinically and radiologically according to the ACR criteria for knee OA. RESULTS: A total of 655 subjects was interviewed. The frequency of symptomatic knee OA was significantly lower in daily milk consumers (p < 0.05). Tea consumption was also inversely associated with symptomatic knee OA (p < 0.05), although other nutritional elements showed no significant relationship with OA. CONCLUSION: Milk consumption may have beneficial effects on symptomatic knee OA.

Vegetable oils used as vitamin E vehicle affect the electrical activity of the rat heart.

The aim of this study is to define the possible effects of vegetable oils used as vitamin E vehicle on the electrical activity of the rat heart. To test the possible effects of vitamin E vehicles we studied the effect of i.p. injected corn oil, hazelnut oil or peanut oil on the action potential parameters recorded in both papillary and left atrial muscle strips. Four experimental groups were used. The control group was injected (i.p.) with distilled water, while the three remaining groups received injections of corn oil, hazelnut oil, or peanut oil for five weeks (in a dose of 0.4 ml/kg/day--minimum amount of oil in which vitamin E could be dissolved). We used borosilicated (15-20 megaohms) capillary electrodes and intracellular action potentials (AP) were recorded in isolated papillary and left atrium muscle strips. While administration of three different types of vegetable oil had no significant effect on AP parameters of papillary muscle, they significantly prolonged the repolarization phase of AP in atrial strips. These results show that vegetable oils used as vitamin E vehicles may alter the electrical activity of the heart in a tissue-dependent manner. The present data indicate that the possible effect of vegetable oil vehicles should be kept in mind while evaluating the possible effects of in vivo vitamin E administration.

The evaluation of sacroiliitis using 99mTc-nanocolloid and 99mTc-MDP scintigraphy.

The role of imaging studies in the evaluation of patients with sacroiliitis is controversial. We aimed to evaluate the role of nanocolloid and bone scintigraphy in patients with sacroiliitis and to investigate the clinical relevance of imaging findings. Thirty-two patients with clinically sacroiliac disease (nine females, 23 males, aged 22-47 years) underwent scintigraphic and radiographic examinations and all imaging studies were performed within 2 weeks. Twenty-five subjects were also included as a control group (10 females, 15 males, aged 20-51 years) for quantitative analysis of the bone scan. The quantitative analysis was done by using regions of interest drawn over the right and left sacroiliac (SI) joint and sacrum (S) and SI/S ratios were calculated. Abnormal uptake was defined as an uptake higher than the mean +/- 2 SD of the control SI/S values. Bone scintigraphy was performed using a three-phase technique and single photon emission computed tomography (SPECT). Nanocolloid scintigraphy (NS) was performed 1 h later, after administration of 370 MBq 99mTc-nanocolloid, and evaluated visually. Each of the scintigraphic examinations was performed on separate days within the same week. Sensitivity values were 25%, 47%, 69% and 97%, and specificity values were 80%, 90%, 95% and 90% in quantitative bone scanning (QBS), 99mTc-NS, planar and SPECT bone imaging, respectively, when the clinical findings were considered as the 'gold standard'. Our results showed that bone SPECT scanning was more sensitive than planar imaging, but planar imaging was the most specific method. SPECT was also the most associated technique with clinical findings. 99mTc-NS was neither specific nor sensitive enough in the detection of sacroiliitis although it could be helpful for the confirmation of inflammation.

Quantitative sacroiliac joint scintigraphy in normal subjects and patients with sacroiliitis.

The aim of this study is to determine the sacroiliac index (SII) of healthy subjects and to compare these values with patients having sacroiliitis (SI). Quantitative sacroiliac scintigraphy (QSS) was performed with Tc-99m hydroxy methylene diphosphonate (HMDP) and whole sacroiliac joint-to-sacrum ratio was calculated as a SII by the region of interest (ROI) method. Forty-seven nonarthritic healthy subjects and 13 patients with SI were studied. Effects of aging, gender and laterality on SII were evaluated in 47 healthy subjects. The sacroiliac index was higher in men than women (p < 0.05). SII did not change significantly in aged men, but it decreased significantly in aged women (p < 0.05). Eleven of 13 patients with SI had a higher SII than healthy subjects (> mean + 2SD). In the other two cases by using small ROIs, SIIs were found to be higher than the normal range. Our results suggest that QSS is a sensitive method for the diagnosis of early stage SI and every institution should establish its own normal SII.

Primary fibromyalgia and allergy.

Primary fibromyalgia (PF) has attracted much interest since the 80's. There are many controversies as to whether it is a true disease or not and many studies are carried on. In this study 32 patients which were accepted as PF were examined for some frequent symptoms and allergy and compared with controls. Migraine, irritable bowel syndrome, sleep disturbance and morning stiffness were investigated and found to be 40.6%, 12.5%, 71.9%, 68.8% respectively. Sleep disturbance and morning stiffness showed a positive correlation. Allergy background of PF patients was found frequently when compared with an age and sex matched control group. Though serum IgE levels were found elevated in PF group, they were not statistically significant. Allergic skin tests which could not be performed in the control group, were positive in 10 of 15 PF patients.

HLA B27 and clinical features in Reiter's syndrome.

HLA B27 and other clinical findings were investigated in 18 Turkish patients with Reiter's syndrome (mean age 35.8 +/- 8.09). Male/female ratio was 2/1. All 18 patients were seronegative, 12 (66.6%) presenting with an asymmetrical oligoarticular arthritis. Radiological sacroiliitis and enthesopathy was found in 9 (50%) and 7 (45.6%) patients respectively. HLA B27 was present in 11 (61.1%) patients.