REHABILITATION APPROACH AFTER EARTHQUAKE DISASTER: A BRIEF REPORT FROM TURKEY.

Devastating earthquake disasters are experienced all over the world. On February 6, 2023, two major earthquakes with magnitudes of Mw 7.7 and 7.6, respectively, occurred centered in Kahramanmaras, Turkey. It resulted in at least 50,783 deaths and more than 122,000 injuries according to official data. Defining the post-earthquake experiences and earthquake risk assessment well and identifying the deficiencies will guide the coordination, management, and planning of subsequent disasters. In this study, the rehabilitation approaches of earthquake victims with physical injuries in our rehabilitation center are emphasized and the situations that will be encountered in the immediate, intermediate, and long-term periods after the earthquake are summarized.

Low back pain and kinesiophobia in pregnant women.

BACKGROUND: During pregnancy, many pregnant women experience lumbopelvic pain due to mechanical, systemic, and hormonal reasons and this pain and fear of movement (kinesiophobia) causes daily life limitations. OBJECTIVE: To examine low back pain (LBP), kinesiophobia, disability, and related conditions that develop together during pregnancy. METHODS: The was a cross-sectional and analytical study. The presence, severity, and duration of pain in the lumbopelvic region were questioned. Postpartum LBP was evaluated using a self-administered questionnaire, disability using the Oswestry Disability Index (ODI), pain intensity using a visual analog scale (VAS), physical activity levels using the physical activity level during pregnancy questionnaire and the international physical activity questionnaire short form, and kinesiophobia was evaluated using the Tampa Scale for Kinesiophobia. RESULTS: The study comprised 120 pregnant women with a mean age of 27.4 ± 6.1 years. It was observed that 42.3% of the pregnant had LBP (n= 69). The mean body mass index (BMI) was 73.6 ± 16.2 kg/m2, and the mean VAS score was 5.5 ± 2 cm. When we divided the group according to the presence of LBP, age (p= 0.49), gestational week (p= 0.75), and gravida (p= 0.81) were similar. BMI (p= 0.038) and ODI scores (p< 0.001) were higher in the group with LBP. CONCLUSION: LBP in pregnant women has a higher frequency than in the normal population, regardless of age, gestational week, and gravida. Obesity appears to be a risk factor for LBP and increases disability. Kinesiophobia in pregnant women is significantly associated with obesity and disability. Unless there are contraindications, a physically active pregnancy process and regular exercise should be recommend.

Evaluation of visual reaction time in patients with fibromyalgia syndrome.

Fibromyalgia syndrome (FMS) has previously been linked to cognitive dysfunction. The aim of this study was to compare visual reaction time (RT) between FMS patients and healthy subjects. The relationship was examined between RT and clinical parameters in FMS patients, and it was aimed to evaluate the effect of drugs used in the treatment of FMS on RT. A total of 112 FMS patients and 110 healthy volunteers were included in this cross-sectional research. Cognitive performance was evaluated with visual RT measurements. FMS patients were assessed using the Fibromyalgia impact questionnaire (FIQ), Beck Depression Inventory (BDI), Fatigue Severity Scale (FSS) and Pittsburgh Sleep Quality Index (PSQI). The drugs used in the treatment of FMS were recorded. Significantly prolonged visual RT measurements were detected in FMS patients (p < 0.001). There was no significant difference in RT measurements between the patients who did not use drugs and those who were treated with serotonin noradrenaline reuptake inhibitor, gabapentinoid and combination therapy (p > 0.05). RT was significantly correlated with FIQ, BDI and PSQI scores in FMS patients (rho: 0.290, p = 0.002 for FIQ; rho: 0.253, p = 0.007 for BDI and rho: 0.312, p = 0.001 for PSQI). No significant correlation was detected between RT scores and FSS values (p > 0.05). Visual RT measurements were seen to be deteriorated in FMS patients. As the disease severity, depression level, and sleep disturbance increased, so the impairment in visual RT values became more prominent. The drugs used in the FMS treatment did not influence the RT scores. Cognitive performance tests should be incorporated in the physical examination and follow-up courses of FMS patients.

The relationship between cervical proprioception and balance in patients with fibromyalgia syndrome.

Proprioceptive abnormalities, balance, and postural disorders have been previously reported in fibromyalgia syndrome (FMS). Unlike previous research, the aim of this study was to compare the proprioception of the cervical region of patients with FMS with a healthy control group. The relationship between cervical proprioception impairment and loss of balance was also examined. A total of 96 female FMS patients and 96 female healthy control subjects were enrolled in this case-control study. The cervical joint position error test (CJPET) was administered to the patient and control groups for cervical proprioception evaluation. FMS patients were assessed with a visual analogue scale (VAS), fibromyalgia impact questionnaire (FIQ), and fatigue severity scale (FSS). Balance tests were applied to both groups. FMS patients had significantly impaired CJPET results in all directions (p < 0.001). There were significant positive correlations between FIQ scores and CJPET results (r = 0.542 and p < 0.001 for right rotation; r = 0.604 and p < 0.001 for left rotation; r = 0.550 and p < 0.001 for flexion; r = 0.612 and p < 0.001 for extension). Significant correlations were found between CJPET measurements and balance tests (for sit-to-stand test; r = 0.510 and p < 0.001 for right rotation; r = 0.431 and p < 0.001 for left rotation; r = 0.490 and p < 0.001 for flexion; r = 0.545 and p < 0.001 for extension), (for timed up and go test; r = 0.469 and p < 0.001 for right rotation; r = 0.378 and p < 0.001 for left rotation; r = 0.410 and p < 0.001 for flexion; r = 0.496 and p < 0.001 for extension) and (for one-legged balance test; r = -0.479 and p < 0.001 for right rotation; r = -0.365 and p < 0.001 for left rotation; r = -0.392 and p < 0.001 for flexion; r = -0.469 and p < 0.001 for extension). Cervical proprioception and balance were impaired in FMS patients. As the disease activity and fatigue level increased, so the deterioration in cervical proprioception became more evident. There were correlations that demonstrated an association between impaired cervical proprioception and poor balance tests. Therefore, proprioception and balance assessments should be integrated into the physical examination processes of FMS patients.

Prevelance of upper extremity lymphedema and risk factors in patients with mastectomy: Single-center, observational, cross-sectional study.

OBJECTIVE: Upper extremity complaints are frequently encountered in breast cancer. It was aimed to investigate the pain, extremity pain, and limitation of motion, lymphedema prevalence, severity, risk factors and quality of life in patients with breast cancer followed by mastectomy in our center. MATERIALS AND METHODS: The study included 67 patients with mastectomy. The presence of lymphedema, lymphedema duration, and grade of lymphedema were recorded. Grip strength was measured on both hands using a dynamometer; arm, shoulder and hand problems were evaluated using the disabilities of the arm, shoulder, and hand. Quality of life was assessed using the World Health Organization Quality of Life scale-short form. RESULTS: The presence of lymphedema was 23.9%; the most common was international society of lymphology grade 1 (76.1%); the median lymphedema duration was 12 (range, 3-72) months. Radical/modified radical mastectomy (58.2%) was the most common type of surgery. Median pain score in the affected extremity according to the visual analogue scale was 2 (minimum: 0/maximum: 7); the presence of shoulder pain was 40.3%; shoulder movement limitation was 7.5%. CONCLUSION: It was found that lymphedema had a negative effect on quality of life by affecting shoulder, arm, and hand functions even in the early stages. The recognition of risk factors and signs of upper extremity complications in breast cancer survivors will contribute to rehabilitation success.

Relationship of leptin, growth hormone, and insulin-like growth factor levels with body mass index and disease severity in patients with fibromyalgia syndrome.

OBJECTIVE: A high prevalence of obesity in fibromyalgia syndrome (FMS) predisposes patients to metabolic changes. It is not clear how the clinical manifestations of the disease affect metabolism. This study aimed to investigate leptin, growth hormone (GH), and insulin-like growth factor (IGF-1) levels in FMS, and their relationship with body mass index (BMI) and disease severity. METHOD: This case-control study included 60 patients with FMS and 42 age- and sex-matched healthy controls. BMIs were recorded for all participants. The disease severity was assessed using the Fibromyalgia Impact Questionnaire (FIQ) and a visual analog scale (VAS). The serum levels of leptin, GH, and IGF-1 of all participants were measured using specific enzyme-linked immunosorbent assays. RESULTS: Both groups had similar age (p = 0.058), sex (p = 0.25), and BMI (p = 0.29) distribution. The mean age of the FMS and the control groups was 40.7 ± 10.8 years and 36.2 ± 13.6 years, respectively. The mean BMI was 26.7 kg/m2 in the FMS group. The GH (p = 0.037) and IGF-1 (p = 0.002) levels were statistically lower, and leptin (p = 0.002) levels were considerably higher in the FMS group than in the control group. The leptin values were positively correlated with age (p = 0.001; r = 0.386) and BMI (p < 0.001; r = 445). Insulin-like growth factor levels were negatively correlated with age (p < 0.001; r = - 0.605) and BMI (p < 0.001; r = - 0.564). Similarly, GH levels were negatively correlated with age (p = 0.040; r = - 0.243) and BMI (p < 0.001; p = - 0.420). None of the three hormones were associated with FIQ and VAS. CONCLUSION: We found that leptin (high), GH (low), and IGF-1 (low) levels were statistically different, together with being independent of disease severity (FIQ, VAS), and correlated with BMI in the FMS group. These findings may be related with hypothalamo-pituitary axis dysfunction, BMI, and energy metabolism.

Quality and readability of online information on ankylosing spondylitis.

INTRODUCTION/OBJECTIVE: Obtaining online health-related information is becoming increasingly popular among patients. The attainment of information through websites is easy and practical, but there is no mechanism to check the accuracy and quality of this information. This leads to concerns about information from websites. Therefore, we aimed to evaluate the quality and readability of ankylosing spondylitis-related websites in this study. METHODS: This is a descriptive study. Websites were searched on a popular search engine with the search term ankylosing spondylitis on March 2, 2019. We recorded the URLs of the first 200 websites listed in the query results. Typologies, quality, and readability were evaluated on these websites. Websites were divided into eight categories (commercial, government, health portal, news, non-profit, professional, scientific journal, and others) according to typology. The JAMA scoring system and the presence of HONcode certification were used to assess the quality. The Flesch-Kincaid grade and the Simple Measure of Gobbledygook were used to evaluate the readability. RESULTS: Of the websites analyzed, 46% were in the high-quality group. We found that scientific journals and news were of higher quality, and commercial and other websites were of poorer quality. The average readability grades of the websites were 8.59 ± 2.42 and 7.33 ± 1.54, which were slightly worse than the recommended value. Additionally, the readability grades were significantly higher on high-quality websites (p < 0.05). CONCLUSION: The quality of information on websites is variable. High-quality information about ankylosing spondylitis is available online, particularly from scientific journals and news. The poor readability of websites that provide high-quality information is a problem for patients with low health literacy. Editors should take into account readability while aiming to present high-quality information on websites. Key Points • Websites have become an important source of health-related information in parallel with the increase in internet use. • Less than half of the ankylosing spondylitis-related websites (46%) were of high quality according to JAMA scores. • The average readability grades of the ankylosing spondylitis-related websites were slightly worse than the recommended values. • High-quality websites had higher readability grades. Therefore, high-quality websites may not be understood by patients with low literacy levels. • No significant difference was found between the websites on the first page (n = 10) and remaining websites (n = 102) in terms of quality and readability.

Evaluation of the relationship between osteoporosis, balance, fall risk, and audiological parameters.

The aim of the study is to investigate the factors such as balance and audiology parameters and bone mineral density (BMD), which were thought to be associated with the increased risk of fall in osteoporotic patients. Ninety-nine female patients between the ages of 40 and 75 were included in the study. Noise exposure, tinnitus, and vertigo were investigated. BMD measurement, Berg Balance Scale (BBS), Timed Up and Go (TUG), and stabilometry tests were applied to the patients. Patients were divided into three groups according to BMD measurements. Patients with a T score of - 1 and below were considered normal (control) (group 1), those with a T score of - 1 to - 2.5 were considered osteopenic (group 2), and those with a T score of - 2.5 and above were considered osteoporotic (OP) (group 3). BBS was 42.06 ± 5.00, 47.74 ± 5.18, and 51.65 ± 3.64 in groups1, 2, and 3, respectively. The difference between the groups was statistically significant (p = 0.001). OP patients had higher oscillation values in all measurements compared with the control group. However, the difference was statistically significant especially on mobile platforms (p < 0.05). Mean tones of pure tone thresholds at 500-8000 Hz for ears were significantly different in patients with OP compared with controls (p < 0.05 for 500-2000 Hz, p < 0.01 for 4000-8000 Hz). This study demonstrated that BMD reduction was correlated with balance parameters and audiological measurements. Therefore, it can be concluded that OP may affect the risk of fracture occurrence not only by decreasing BMD but also by increasing the risk of falling. KEY POINTS: • In the present study, the effects of balance and audiology parameter measurements on osteoporosis (OP) were investigated. In addition, the associations between vertigo, tinnitus, history of falling, body made index, vitamin D, and calcium values and osteoporosis were evaluated. • We determined that bone mineral density (BMD) reduction was related to balance and audiological parameters. It can be speculated that OP may affect the risk of fracture occurrence not only by decreasing BMD but also by increasing the risk of falling. We think that early diagnosis, appropriate treatment, and rehabilitation of hearing loss and OP may decrease the incidence of falling and improve the quality of life of the affected individuals.

The Clinical Importance of the Plasma Atherogenic Index, Other Lipid Indexes, and Urinary Sodium and Potassium Excretion in Patients with Stroke.

OBJECTIVE: Cardiovascular complications are still the primary reason for high mortality rates worldwide. The determination of risk factors is important to prevent stroke. The aim of the present study was to analyze the importance of serum lipid indexes and urinary sodium (Na)/potassium (K) excretion in patients with stroke together with sex differences. MATERIALS AND METHODS: A total of 50 (28 male and 22 female, mean age 65.9±14.6 years) patients with acute stroke were included in the study group, and 32 body mass index-matched healthy subjects were included in the control group. Lipid profiles [(cholesterol, triglyceride, very low-density lipoprotein, low-density lipoprotein, and high-density lipoprotein (HDL)], serum creatinine (Cre), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and Na, K, and Cre excretion in spot urine samples of the patients were recorded. RESULTS: Systolic blood pressure (p=0.021), ESR (p=0.044), and CRP (p=0.042) were significantly higher in all patients in the stroke group; urinary Tanaka (K) (p=0.033), Kawazaki (K) (p=0.028), urinary spot Cre (p=0.012), and Na excretion (p=0.036) levels were found to be significantly lower in only male patients with stroke. The mean plasma atherogenic indexes were 0.57±0.24 in the study (stroke) group and 0.54±0.22 in the control group (p=0.61). Other lipid indexes, such as Castelli's risk index (CRI)-I (p=0.29), CRI-II (p=0.24), atherogenic coefficient (p=0.29), and non-HDL cholesterol (p=0.69), were not statistically different from the controls. CONCLUSION: Urinary Na, K, and Cre excretion was significantly lower in male patients with stroke, and acute phase reactants were significantly higher in the entire stroke group than in controls. These parameters can be used as auxiliary biomarkers in the risk assessment of stroke.

Angiotensin converting enzyme and neprilysin inhibition alter pain response in dexhamethasone-induced hypertensive rats.

BACKGROUND: We hypothesized that renin-angiotensin system and neprilysin (NEP) inhibition can modulate the nociceptive parameters on hypertensive rats. The aim of this study is to assess the preventive and therapeutic effects of ramipril and sacubitril on the pain hypersensitivities, and their interaction mechanisms with high blood pressure. METHODS: Antinociceptive effects of ramipril and sacubitril were compared with those of diclofenac. Threshold of pain assesments were recorded before drugs administration. After a 18 days treatment, normotensive and dexamethasone-induced hypertensive rats were evaluated on thermal hyperalgesia and mechanical allodynia tests. Blood pressure of rats were verified by mean arterial pressure measurement. RESULTS: Hypertensive rats showed significantly high pain threshold on thermal plantar test compared to that of normotensives. Among hypertensive rats, pain hypersensitivity was lowest in diclofenac group, followed by sacubitril group, while ramipril caused increased thermal and mechanical hypersensitivities. CONCLUSION: We found that NEP inhibition may play a role in nociception in hypertensive rats. NEP inhibitors may be suitable choice for the management of hypertension and pain because of their therapeutic and preventive effects on nociception and arterial blood pressure.

YouTube as a source of patient information for ankylosing spondylitis exercises.

INTRODUCTION/OBJECTIVES: Ankylosing spondylitis (AS) is a rheumatic disorder characterized by structural impairments and postural deformities which restrict daily life activities. Nonpharmacologic methods, particularly exercise therapies, play a key role in the treatment. Obtaining online health-related information has become increasingly popular. We aimed to assess the quality of the most viewed YouTube videos on AS exercises. METHOD: We searched for the key words "ankylosing spondylitis exercise," "ankylosing spondylitis rehabilitation," "ankylosing spondylitis physical therapy," and "ankylosing spondylitis physiotherapy" on YouTube on October 10th, 2018. The educational quality of YouTube videos was evaluated according to the Global Quality Scale, and three groups were formed: high quality, intermediate, and low quality. Video parameters were compared between the groups. RESULTS: Of the 56 videos evaluated, 48.2% (n = 27) were of high quality, 17.9% (n = 10) were of intermediate quality, and 33.9% (n = 19) were of low quality. When video parameters compared among the groups, no significant differences were found in the number of views per day, likes per day, and comments per day (p > 0.05). Significant differences were found in the number of dislikes per day and DISCERN scores between the groups (p = 0.02, p < 0.001, respectively). CONCLUSIONS: YouTube can be considered as an important source of high-quality videos. Nearly half of the videos were of high quality. Physicians should inform patients about the importance of video resources during the use of YouTube and should guide patients to the accurate sources of information.

Foot functions in ankylosing spondylitis.

ABTRACT: AIM: Because of the wide diversity of developmental stages in spondyloarthropathies (SpA), clinical and radiographic weak correlations are often found in the development of enthesopathies. In this study, foot functions of ankylosing spondylitis (AS) patients were analyzed with clinical and radiological features. METHOD: Sixty-two AS patients and 39 age-matched, gender-matched, and body mass index (BMI)-matched healthy volunteers were included in this study. Acute-phase reactant levels of participants were recorded. The disease activity and functionality were assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI). Foot functional index (FFI) and timed up and go test (TUG) were performed by the same educated nurse. Radiographically, the SpA-tarsal radiographic index (TRI) and the calcaneal inclination angle (CIA) were measured by the same physician to assess midfoot and arches. RESULTS: FFI subscores and total, TUG results, and CIA measurements were found to be significantly higher in the AS group (p < 0.05). FFI-pain, FFI-disability, and FFI-activity limitation subscores were significantly and positively correlated with BASDAI and BASFI scores (p < 0.05). Radiological changes ranging from grade 1 to grade 4 were detected in 68% of the AS paients according to TRI. Nineteen AS patients had pes planus and 26 AS patients had pes cavus deformity. CONCLUSION: The foot and ankle are frequently affected during the course of AS. Foot involvement and its functional impacts should be assessed regardless of the disease activity parameters in AS patients.

Comparison of vascular arterial stiffness parameters of adolescent wrestlers with healthy subjects: Is heavy training harmful for wrestlers?

BACKROUND: The effect of different exercise modalities on the vascular structure has been the subject of clinical trials but there is not enough data about wrestlers. OBJECTIVE: This study aimed to compare the arterial stiffness parameters in adolescent wrestlers with those of age-matched sedentary controls to show the effects of long and heavy training. METHODS: This study was carried out as a case-control study. Thirty three (N= 33) elite male adolescent wrestlers (12-18 years) and 35 age and sex-matched control subjects (P= 0.438) with a sedentary lifestyle were included the study. The data was obtained by using sonography and a sphygmomanometer. Systolic and diastolic diameters and intima media thickness (IMT) measurements were performed from the carotid arteries of the subjects. The arterial tension was measured in the same session, and arterial stiffness parameters were calculated using specific formulas. RESULTS: The mean age range was 15.9 ± 0.9 years and 16.0 ± 0.8 years for the wrestlers and control subjects, respectively (P= 0.43). Statistically, the Body Mass Index (BMI) was significantly higher in wrestlers (mean = 23.7 ± 4.0 kg/m2; P= 0.00). The groups had no difference in height (P= 0.80) and weight (P= 0.05). The systolic blood pressure (SBP) was significantly higher in wrestlers (mean = 120 ± 13.4 mmHg; P= 0.00); the pulse was significantly lower in wrestlers (mean = 69.61 ± 17.2 beats/min; P= 0.00); the IMT was significantly lower in wrestlers (IMT mean = 0.288 ± 0.1 mm; P= 0.01); the diastolic wall stress (DWS) was significantly higher in wrestlers (DWS mean = 933.64 ± 298.0 mmHg; P= 0.03) than controls. No significant differences were found in the elastic modulus (P= 0.11), compliance (P= 0.86), and distensibility (P= 0.86) parameters between the groups. CONCLUSION: Bradycardia is an expected condition for athletes. SBP and DWS were found to be high in wrestlers, suggesting that arterial tissue is more susceptible to stress. The low IMT indicates the protective effect of regular exercise against atherosclerosis. It is known that regular exercise is good for the vascular structure while heavy exercise puts a load on the vascular structure. The fact that the elastic modulus, compliance, and distensibility do not differ between the groups suggests that structural changes in the adolescents have no effect on the vascular wall.

Is it Possible to Recover Cardiac Functions After Total Knee Arthroplasty?

BACKGROUND: Patients suffering from knee osteoarthritis lead a less active life than their healthy peers. It is well known that insufficient physical activity is the most common cause of chronic diseases. However, there is not enough research to enlighten the effect of increased functional capacity on cardiac functions after Total Knee Arthroplasty (TKA). This study aimed to investigate whether the orthopedic surgeons can predict that the patients will be healthier after TKA in terms of cardiac functions or not? METHODS: 109 patients who underwent TKA were prospectively followed for one year. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and short form 36 (SF-36) surveys, BMI measures, average step count per day, the six-minute walking test (6MWT), the Five-Times-Sit-to-Stand Test (FTSST) and Doppler echocardiography were performed both in the preoperative and postoperative period. RESULTS: After TKA, there was a substantial improvement in terms of WOMAC and SF36 survey scores. The average step count increased from 2199.6±690.8 steps/day to 4124.3±1638.8 steps/day. 6MWT and FTSST improved significantly as well. The average brisk walking time was 174.23±95.11 minutes/week. The means of early and late mitral inflow velocity ratios (E/A and Em/Am ratios) increased from 0.71±0.12 to 0.77±0.13 and from 0.66±0.13 to 0.76± 0.15 at the first year follow-up visit, respectively (p<0.001). CONCLUSION: In the first year, objective physical capacity measures increased together with the expected improvements in disease-specific and generic measures. After TKA, left ventricular diastolic functions may be considered to have recovered in the light of the healing signs via echocardiography.

Ultrasound elastography-based assessment of the elasticity of the supraspinatus muscle in impingement syndrome: does elastography has any diagnostic value?

Ultrasound elastography (UE) is a new ultrasound-based imaging technique that provides information about elasticity and stiffness of tissues. This cross-sectional study aimed to identify the diagnostic importance of UE in supraspinatus impingement syndrome. Forty-one subjects, aged 38-70 years, were included in the study. UE was used to determine the elasticity of the supraspinatus muscle. The strain ratio was calculated as the evaluation criteria to measure the elasticity of the muscle. High strain ratio indicated low elasticity. The measurements were made by the blinded radiologist while the patients sat with their shoulder in a neutral position. The diagnostic value of the strain ratio was evaluated using the receiver operating characteristic (ROC) analysis. The mean strain value of the supraspinatus muscle on the intact and pathological shoulders determined by UE was 0.74 ± 0.33 and 0.31 ± 0.24, respectively. A low strain ratio value in the supraspinatus muscle on the side with impingement syndrome was measured. When the test variable was evaluated as "strain ratio" according to ROC curve analysis, it was found to be above the reference line [0.849 (> 0.5)] (P = 0.00). When the cutoff value was selected as 0.495, the sensitivity and specificity were found to be 75.6 and 78% (the strain ratio value > 0.495), respectively. Measurement of strain ratio with UE can be used as a noninvasive, inexpensive, and practical diagnostic test for the shoulder impingement disease.

Clinical Significance of Serum Bilirubin in Behçet's Disease.

BACKGROUND AND OBJECTIVE: Bilirubin (Bb) is the product of the intravascular compartment of catabolic pathway. In a small number of clinical trials, it has been shown that Bb molecules are associated with cardiovascular diseases, diabetes, cancer, autoimmune (lupus, rheumatoid arthritis) diseases and schizophrenia. Behçet's disease is a chronic, multisystemic, inflammatory vasculitis that was first described by Hulusi Behçet in 1937, which affects almost all organs and systems without any known aetiology. Here, we investigated the clinical significance of serum Bb as a biomarker in the patients with Behçet's disease. METHODS: Seventy-one (N = 71) patients with Behcet's diagnosis within the last 1 year were included retrospectively. Control group consisted of 75 subjects with similar age and sex distribution. Serum Bb, indirect Bb, total Bb, aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP) and erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) data were recorded from the hospital records. RESULTS: In the Behçet group, direct Bb was significantly lower (P = 0.011), ESR and CRP were significantly higher (P = 0.00). No significant differences were observed in other parameters. In the whole group, total Bb and indirect Bb were negatively correlated with ESR (P = 0.025, P = 0.01). Direct Bb was negatively correlated with CRP (P = 0.002). For the diagnosis of Behçet, direct Bb with a threshold of < 0.14 can be used as a diagnostic test (P = 0.000) with 70% sensitivity, 68% specificity (area under the curve = 0.69; 95% confidence interval 0.59-0.80) in ROC curve analysis. CONCLUSION: According to our study, we found that inflammatory markers were high and direct Bb values were low in patients with Behcet's disease. In addition, Bb parameters were negatively associated with acute phase reactants. As a practical biomarker with anti-oxidative properties, the direct Bb can be used to diagnose and clinical follow-up in cases with Behçet's disease.

Ultrasound elastography findings in piriformis muscle syndrome.

BACKGROUND: Piriformis muscle syndrome (PMS) is relatively less known and underestimated because it is confused with other clinical pathological conditions. Delays in its diagnosis may lead to chronic somatic dysfunction and muscle weakness. OBJECTIVE: Here, we aimed to evaluate the diagnostic performance of the ultrasound elastography (UE) as an easy, less-invasive, and cost-effective method for early diagnosis of PMS. MATERIALS AND METHODS: Twenty-eight cases clinically diagnosed as PMS at the outpatient clinic were evaluated by UE. The elastographic strain ratio was calculated by dividing the strain value of the subcutaneous fat tissue by the mean stress value of the muscle beneath. The diagnostic performances of the strain rate measures were compared using the receiver operating characteristic curve analysis. RESULTS: Twenty-one (N = 21) cases were female, and seven (N = 7) of the cases were male. The mean age was 45 years (ranged 24-62 years). The strain rates of piriformis muscle (PM) and gluteus maximus (GM) muscles were significantly higher on the PMS-diagnosed side (P < 0.001). The cutoff value of UE strain ratio for the PM and GM were 0.878 [95% confidence interval (CI) 0.774-0.981] and 0.768 (95% CI 0.622-0.913), respectively, and the sensitivity and specificity values were, respectively, 80.95% and 85.71% for the PM, and they were, respectively, 85.71% and 66.67% for the GM. CONCLUSION: We showed that the muscle elasticity and tissue hardening increased on the problematic side both on PM and GM. UE may provide early diagnosis of PMS, thereby increasing the possibility of treatment with less invasive methods.

Clinical features of patients diagnosed with degenerative rotator cuff tendon disease: a 6-month prospective-definitive clinical study from turkey.

[Purpose] In rotator cuff tendon disease (RCTD), anamnesis is as important as clinical findings and anatomic/radio diagnostic examination. This study aimed to investigate the clinical features of patients diagnosed with RCTD using clinical and radiological methods between March 2015 and August 2015 at Malatya Research and Training Hospital Physical Medicine and Rehabilitation department. [Subjects and Methods] The study included 178 patients who were diagnosed with RCTD (128 females and 50 males). A questionnaire comprising 33 questions was given to each patient. [Results] Eighty-eight of the patients (49.9%) had an involvement on their right side, eighty-four (47.1%) had an involvement on their left side, and 6 had bilateral involvement. Mean visual analog scale (VAS) score was found to be statistically significant in favor of female patients. A statistically significant correlation was found between educational status and VAS. The body mass index (BMI) of the female patients was found to be higher than that of the male patients. Statistically significant correlation between doing risky work and gender showed that males were at a higher risk. [Conclusion] RCDT is more seen in people who have high BMI and are at their 50s. Pain complaint and BMI were found higher in female patients. DM, thyroid and cardiac diseases were seen more in the patients who are diagnosed with RCTD relative to the healthy population.

Does obesity cause chronic inflammation? The association between complete blood parameters with body mass index and fasting glucose.

OBJECTIVE: This study aimed to determine the relationship of complete blood count (CBC) parameters and derivates with fasting blood sugar and the body mass index. METHODS: This was a prospective, observational clinical study. Hospitalized patients who received a physiotherapy program in the Physical Medicine and Rehabilitation Clinic between March and June 2016 were included. The age, height, weight, body mass index (BMI), fasting blood glucose, erythrocyte sedimentation (ESR), C-reactive protein, and CBC parameters (leukocytes, platelets, neutrophil, lymphocytes, and monocytes) and red cell distribution width, platelet distribution width, neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio of the patients were recorded. The relationship between the BMI, fasting glucose, and CBC parameters and derivates were investigated. Patients were divided into groups based on BMI: BMI≤25 kg/m2, normal; BMI=26-30 kg/m2, overweight; and BMI>30 kg/m2, obese. A P value>0.005 was considered statistically significant. RESULTS: A significant difference in the lymphocyte count, ESR, and NLR values was observed among the three groups (P=0.011; P=0.021; P=0.04). A significant difference in NLR was found between groups 1 and 3 (P=0.04). Between groups 1 and 3, a significant difference in platelet count was noted (P=0.013). On dividing the patients into two groups: normal and overweight/obese, a significant difference in lymphocyte count, glucose, and ESR values was observed (P=0.038; P=0.05; P=0.013). The lymphocyte count, ESR, and glucose values were found to be higher in the overweight group. According to Spearman's correlation analysis, the BMI and NLR values were found to be negatively correlated (P=0.029; r=.145); however, the lymphocyte count and ESR values were positively correlated (P=0.009; r=.173); (P=0.013; r=.182). CONCLUSION: This study found a negative correlation between the NLR and BMI values and a lower NLR value in the obese group compared with the normal group. The overweight group showed a higher lymphocyte count, thereby confirming the positive correlation of lymphocyte count with BMI. A comprehensive clarification of the mechanisms underlying the relationship between obesity and inflammation may allow developing treatment strategies to reduce the negative effects of obesity.