Arthroscopic Bankart repair improves upper limb exercise capacity, shoulder function and quality of life.

BACKGROUND: Anterior glenohumeral instability is an important cause of shoulder disability. The aim of the present study was to investigate arm exercise capacity in patients with anterior glenohumeral instability before and after arthroscopic Bankart repair and to compare the results with those of healthy controls. METHODS: The patient group included a total of 11 males between the ages of 18 and 40 years. The control group consisted of 13 healthy males with an age range of 23 to 41 years. An incremental arm crank exercise test was performed to determine upper limb exercise capacity, as expressed by peak oxygen consumption (VO2peak). The shoulder function of the patients was evaluated by the Western Ontario Shoulder Instability Index (WOSI), and the quality of life was assessed with the Short Form-36 (SF-36). All evaluations were performed preoperatively, and at the postop 3rd and 6th months. RESULTS: The patient group had lower VO2peak and exhaustion duration at the preoperative assessment (p = 0.025 and p = 0.007, respectively). SF-36 domains were lower in patients (p < 0.05). There were significant differences in VO2peak between preoperative and postop 6th-month measurements and between postop 3rd and 6th-month measurements (p < 0.001 and p = 0.001, respectively). The total WOSI score increased from preoperative 50.27% to 57.77% at the postop 3rd month, and to 65.56% at the final follow-up. Although improvements were detected in all SF-36 domains at postop follow-ups, they were not statistically significant except role limitations due to the physical problems domain (p = 0.006). There were no significant differences between controls and patients at the postop 3rd and 6th months with regard to exercise test parameters except the peak rating of perceived exertion. DISCUSSION: Shoulder function, exercise capacity, and quality of life were lower in the patient group and improved after arthroscopic Bankart repair. Clinicians should use the exercise capacity assessment for the evaluation of the recovery of shoulder function after providing stabilization.

Ultrasound assessment of distal femoral cartilage thickness measurements after walking/jogging in subjects with pes planus.

BACKGROUND: Because there is a closed kinematic chain between the lower extremity joints during weight-bearing activities, pes planus can affect knee biomechanics. OBJECTIVE: This study aimed to measure distal femoral cartilage thickness with ultrasound after 3 different conditions (at rest, during walking and jogging) in subjects with pes planus and compare these conditions with each other and also with controls. METHOD: Sixteen participants with pes planus(5-men, 11-women; aged 18-30 years) and 16 controls(3-men, 13-women; aged 18-30 years) were enrolled. Distal femoral cartilage thickness was evaluated with ultrasound before and after three separate 30-min conditions. Preferred walking speed (PWS) was determined on the ground. Subjects walked on a treadmill for 30-min at their PWS and jogged 30-min at 30% above their PWS. The Foot Function Index and the Foot-Ankle Outcome Survey were used to evaluate the clinical and functional status of the subjects. RESULTS: Neither PWSs nor jogging speeds were statistically different between groups (p > 0.05). There were no statistically significant differences between groups for absolute and percent change of cartilage thickness for all three conditions (p > 0.05). There were also no statistically significant differences between conditions for each intragroup (p > 0.05). The median Foot Function Index score of the subjects with pes planus was 9.78(0-44.35) for the right foot and 9.52(0-40.87) for the left foot. The median the Foot-Ankle Outcome Survey score of the subjects with pes planus was 88(65-100). CONCLUSION: There was no difference in knee joint cartilage deformations under different loading conditions, neither in subjects with pes planus nor in controls.

Pulmonary Functions in Patients With Chronic Neck Pain: A Case-Control Study.

OBJECTIVE: The purpose of the study was to investigate pulmonary functions of patients with chronic neck pain and compare them with those of asymptomatic controls. METHODS: This case-control study was conducted with 25 patients with chronic neck pain (age, 26.84 ± 7.89 years) and 27 age-matched asymptomatic controls (age, 25.96 ± 7.13 years). Pulmonary function tests were performed using spirometry (Quark PFT, COSMED, Rome, Italy). Forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), forced expiratory flow at 25% to 75% vital capacity, peak expiratory flow, maximum voluntary ventilation, and the FEV1/FVC ratio were measured and are expressed as (%) predicted value for patients with chronic neck pain and asymptomatic controls. RESULTS: The chronic neck pain group had lower FEV1 (P = .015), FVC (P = .029), forced expiratory flow at 25% to 75% vital capacity (P = .040), and maximum voluntary ventilation (P = .042) compared with asymptomatic controls; however, FEV1/FVC (P = .470) and peak expiratory flow (P = .183) were similar in both groups. CONCLUSION: These results demonstrated that dynamic lung volumes were lower in patients with chronic neck pain compared with asymptomatic controls.

The effects of arm crank training on aerobic capacity, physical performance, quality of life, and health-related disability in patients with Parkinson's disease.

BACKGROUND: Aerobic exercise training contributes to improvement of cardiopulmonary capacity, mobility, neurological function, and quality of life. AIMS: To investigate the effects of arm crank ergometer training on aerobic capacity, quality of life, and Parkinson's disease (PD)-related disability METHODS: Seventeen patients with PD were recruited to study. Assessments were performed at baseline and at the end of an 8-week arm crank ergometer (ACE) training program (3 days/week; 1 h per session, 50-70% VO2peak) with patients acting as their own control. Outcome measures included aerobic capacity assessment, 6-min walk test (6MWT), timed up and go test (TUG), Unified Parkinson's Disease Rating Scale (UPDRS), Parkinson's Disease Questionnaire-39 (PDQ-39), Beck Depression Index (BDI), the Falls Efficacy Scale (FES), and Montreal Cognitive Assessment (MoCA). RESULTS: At the end of the study, an increase of 30.49% in aerobic capacity was observed. Statistically significant improvements were found for the 6MWT (p = 0.001), TUG test (p = 0.001), UPDRS total score (p = 0.002), quality of life assessed with PDQ-39 (p = 0.006), BDI (p = 0.001), and FES scores (p = 0.002) after an 8-week ACE training. No significant effect on MoCA was found (p = 0.264). CONCLUSION: An 8-week ACE training led to significant improvement in aerobic capacity, physical performance, and PD-related disabilities.

Can mean platelet volume and red blood cell distribution width show disease activity in rheumatoid arthritis?

AIM: To evaluate the relationship between mean platelet volume (MPV) and red cell distribution width (RDW), and disease activity in rheumatoid arthritis (RA). PATIENTS & METHODS: Hundred RA and 100 controls were included. RESULTS: MPV and RDW were higher in RA (p < 0.0001). The cut-off levels of RDW and MPV were 14.8 and 10.4. Patients with RDW >14.8 had higher Disease Activity Score 28 (DAS28; p = 0.002) and pain score (p = 0.0007). RDW was positively correlated with DAS28 and pain. But, DAS28 and pain were not different between patients with MPV >10.4 and <10.4. CONCLUSION: MPV and RDW were significantly higher in RA. RDW and MPV were similar to erythrocyte sedimentation rate and C-reactive protein to indicate inflammatory activity. RDW was correlated with pain and DAS28, but MPV was not associated with them.

Sleep quality in patients with chronic low back pain: a cross-sectional study assesing its relations with pain, functional status and quality of life.

OBJECTIVE: The aim of this study was to investigate sleep quality in patients with chronic low back pain (CLBP) and its relationship with pain, functional status, and health-related quality of life (HRQOL). METHODS: Two hundred patients with CLBP aged 20-78 years (mean: 50.2 years) and 200 sex- and age-matched pain-free healthy controls (HCs) aged 21-73 years (mean: 49.7 years) were included in this study. After lumbar region examination, in patients, pain was evaluated with the Short Form-McGill Pain Questionnaire (SF-MPQ), functional capacity with the Functional Rating Index (FRI), and health-related quality of life with the Short Form-36 (SF-36). The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality of both groups.The sleep quality was compared between the patients and HCs. In patients with CLBP, its relations with pain, functional status and HRQOL were also investigated. RESULTS: The patients had significantly higher total scores (8.1 ± 4.3, 4.6 ± 3.4, P< 0.001, respectively) and subscale scores (P< 0.001) for PSQI compared to HCs. The groups were only similar in use of sleeping medication (P> 0.05) Among the patients, sleep quality was worse in women, in the patients with complaints more than 11 years, in the patients with low back and two leg pain (P< 0.05). Mean scores of the FRI, SF-MPQ, and visual analog scale in the patients were 8.5 ± 3.0, 16.7 ± 8.0, 6.9 ± 1.2, respectively. The PSQI total scores of patients were positively related with both SF-MPQ and FRI scores (P< 0.001). Also, there were negative relationships between the physical component summary score of the SF-36 and all subscale scores of the PSQI, without sleep duration of PSQI (P< 0.001). CONCLUSION: The sleep quality of patients with CLBP was worse compared to HCs, and there were positive relations between the sleep quality with pain and functional status. Also, the poor sleep quality had negative effect on the physical component of quality of life.

The association between cyclooxygenase-2 (COX-2/PTGS2) gene polymorphism and osteoarthritis.

OBJECTIVES: This study aims to investigate the relationship between the risk for the development of osteoarthritis and Cyclooxygenase-2 (COX 2) -765G>C gene polymorphism. PATIENTS AND METHODS: We included a total of 100 osteoarthritis patients (18 males, 82 females; mean age 60.4±8.4 years; range 41 to 81 years) who were treated in the Physical Therapy Clinic and 100 healthy subjects without a history of arthritis (40 males, 60 females; mean age 30.9±7.5 years; range 16 to 48 years) in our study between September 2006 and May 2008. The frequency of -765G>C gene polymorphism in the COX-2 promoter region was investigated in the osteoarthritis patients and the control group without a history of arthritis using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The data were analysed with chi-square and logistic regression analysis. RESULTS: The frequencies of -765G>C polymorphism for GG, GC and CC genotypes were found to be 54%, 35%, and 11% in the control group and 48%, 34% and 18% in the osteoarthritis group, respectively. CONCLUSION: Based on the data obtained, it can be stated that there is no significant relation between COX-2 -765G>C polymorphism and osteoarthritis disease. Furthermore, this study presents the first results of COX-2 promoter variant in Turkish patients with osteoarthritis.

Arginase, NOS activities, and clinical features in fibromyalgia patients.

OBJECTIVES: Fibromyalgia (FM) is a form of nonarticular rheumatism characterized by chronic widespread musculoskeletal aching and tender points. The aim of the present study was to investigate the effect of arginase and nitric oxide synthase (NOS) enzyme activities in FM with respect to their importance in pathogenesis, and the relationship with FM-related clinical parameters. METHODS: After obtaining informed consent, 25 female FM patients were compared with 23 healthy female controls. NOS and arginase enzyme activities were measured spectrophometrically in sera. Tender points were examined using the protocol described by Wolfe et al. The health status of patients was assessed by Fibromyalgia Impact Questionnaire. Musculoskeletal pain was scored according to visual analog scale. Health Assessment Questionnaire, Beck depression and Beck anxiety scales, and dyspnea scores were administered to analyze functional, psychiatric, and respiratory status of the patients. RESULTS: We found that NOS activity was significantly higher whereas arginase activity was lower in patients with FM. In the correlation analysis, NOS levels showed statistically significant positive correlation with chest pain and dyspnea parameters. NOS enzyme activities were higher in subjects with positive history of migraine, pain, and morning stiffness. On the other hand, arginase levels were lower in subjects with positive history of irritable bowel syndrome and morning stiffness. CONCLUSION: Animal experiments have suggested that nitric oxide (NO) is an important transmitter in pain pathways. It can also stimulate cyclooxygenase activity. We observed increased NOS activity and reduced arginase activity in FM patients, which may be due to increased cyclooxygenase enzyme activity and oxidant/antioxidant imbalance. In conclusion, we think that future studies concerning clinical control of pain with selective NOS inhibitors are needed in order to determine new therapeutic approaches and the exact pathophysiologic mechanisms in FM patients.

The geriatric hand: correlation of hand-muscle function and activity restriction in elderly.

On the basis of the importance of hand manipulation in activities of daily living (ADL), deterioration of hand function because of various factors reduces quality and independence of life of the geriatric population. The aim of this study was to identify age-induced changes in manual function and to quantify the correlations between hand-muscle function and activity restriction in the geriatric age group, through grip and pinch measurements and a set of questionnaires. Twenty-four geriatric (aged 65-79 years) volunteers participated in the study. Bilateral grip and pinch strengths have been recorded. To document impairment of manual functions, self-estimated hand function, Duruöz and Dreiser hand indices, Geriatrics-Arthritis Impact Measurement Scale (GERI-AIMS) manual dexterity questionnaires have been completed. Activity restriction and quality of life of these patients were inquired with short form (SF)-36 and Instrumental Activities of Daily Living (IADL) scores. Grip and pinch strengths correlated best with Duruöz and Dreiser indices. Similarly, SF-36 and IADL had higher correlation coefficients for Duruöz and Dreiser indices. A very good correlation between IADL and SF-36 was calculated too. Male and female participants revealed statistically significant differences for grip and pinch strengths as well as self-estimated hand function and SF-36. Another result was that none of our parameters, including grip strength and SF-36 had differed significantly between the 65-70 and 70-79 years age subgroups. However, grip strength displayed statistically significant lower values when compared with young adult mean values of a previous study. Our data in this study support the hypothesis that hand-muscle function correlates with functional dependency in the elderly. Manual function can be determined by grip strength in addition to multiple available functional tools. In this study, Dreiser and Duruöz hand function indices were the best to correlate with ADL and quality of life.

Obesity related measurements and joint space width in patients with knee osteoarthritis.

BACKGROUND: The aim of this study is to analyze the relationship between body mass index and obesity related measurements and tibiofemoral joint space which have been the principal method of radiographic evaluation in progression and therapeutic trials of knee osteoarthritis. METHODS: Fifty-five female patients with the diagnosis of osteoarthritis in knees according to the criteria of American College of Rheumatology in knees were included in the study. The mean age of patients was 57,42+/-8,60(SD) years with a range of 42-77. Medial and lateral compartment joint space widths were measured on antero-posterior knee radiography. Body mass index, triceps, biceps, subscapular and suprailiac skinfold thickness, waist and hip circumference were measured. Body composition was determined by dual energy X-ray absorpsiometry (DEXA) (Norland XR 46) and total lean mass (g), total fat mass (g), trunk lean mass, trunk fat mass, abdomen lean mass, abdomen fat mass measurements were recorded. RESULTS: Patients with body mass index>30 were accepted as obese patients. According to these criteria 33 of the 55 patients were obese. Tibial medial compartment and tibial lateral compartment measurements of obese patients were significantly lower than nonobese patients (p=0,000, p=0,003 respectively). Body mass index was correlated with total lean mass, total fat mass, trunk fat mass, abdominal fat mass, leg fat mass. Tibial medial compartment and tibial lateral compartment space measurements were negatively correlated with body mass index. CONCLUSION: Our results revealed significant difference in both medial and lateral joint spaces of obese and nonobese patients with knee osteoarthritis. Medial and lateral joint spaces of obese patients were narrower than nonobese osteoarthritis patients. The more body mass index had the patients the narrower joint space they had displayed. However body composition analysis and obesity related measurements did not show additional correlation with tibial compartment measurement.

The effect of hand osteoarthritis on grip and pinch strength and hand function in postmenopausal women.

The aim of the study was to investigate the effect of osteoarthritis on hand function in postmenopausal women. One hundred patients with hand OA and 70 healthy volunteers as controls were evaluated. Grip and pinch strength measurements and Dreiser's functional index were used for hand function. Pain was assessed by a visual analog scale, and tenderness was assessed by palpation and scored, depending on the severity of tenderness, as 0, 1 or 2. Heberden's and Bouchard's nodules and joint involvement were also recorded. The number of patients with only distal interphalangeal joint involvement was 50 (50%), those with distal interphalangeal joint plus proximal interphalangeal joint involvement was 49 (49%), and those with carpometacarpal joint involvement numbered 18 (18%). The incidence of Heberden's and Bouchard's nodules was 85% and 36%, respectively. Eighty-six (86%) patients were suffering from pain and 57 were found to have tenderness. Grip and pinch strength was significantly lower (p<0.05) and Dreiser's functional index score was significantly higher (p<0.001) in the study group (particularly in grade 4 OA). Grip strength was lower in hand OA patients with distal interphalangeal joint plus proximal interphalangeal joint involvement than in those with only distal interphalangeal joint and carpometacarpal joint involvement. Pinch strength was also lower in patients with distal interphalangeal joint plus proximal interphalangeal joint plus carpometacarpal joint involvement. The patients with Heberden's and Bouchard's nodules had lower grip and pinch strength than controls. Also, pain and tenderness had significant (p<0.05) effects on hand function. Dreiser's total score ranged from 0 to 10 in 80 (80%) patients and from 11 to 20 in 20 patients. In conclusion, hand osteoarthritis contributes to hand dysfunction, mainly related to the severity of osteoarthritis, pain, joint involvement and the presence of nodules.

The protective effects of acetylsalicylic acid on free radical production in cisplatin induced nephrotoxicity: an experimental rat model.

Cisplatin-induced nephrotoxicity is closely associated with an increase in lipid peroxidation. In several previous reports it was claimed that acetylsalicylic acid (ASA) shows its therapeutic potential as a free radical scavenger. The aim of the study was to investigate effects of ASA on cisplatin induced nephrotoxicity in an experimental rat model. Control animals (n:7) were administered 1 mL saline solution intraperitoneal (i.p.). Cisplatin group (n:7) was treated with a single dose of cisplatin i.p. (6 mg/kg), ASA group (n:7) was treated with i.p. (2.5 mg/kg) per day during the study, cisplatin plus ASA group (n:7) was administered single dose cisplatin i.p. (6 mg/kg) plus ASA (2.5 mg/kg) during 5 days. At the end of the study, Catalase (CAT), Glutathione Peroxidase (GSH-Px), Superoxide Dismutase (SOD), Nitric Oxide Synthase (NOS) enzymes activities and Malondialdehyde (MDA), Antioxidant Potential (AOP) levels were measured in both erythrocytes and renal tissues. Urea and creatinine levels and renal tissue necrosis in cisplatin plus ASA group were significantly lower than cisplatin group (p = 0.000, p = 0.014, p = 0.015). SODr activities and MDAr levels of cisplatin plus ASA group were also significantly lower than cisplatin group (p = 0.000, p = 0.029). These results show that cisplatin and ASA combination decreases the levels of urea and creatinine, reduces necrosis and improves antioxidant enzyme activities, MDA and AOP in rat kidney.

In vivo effects of meloxicam, celecoxib, and ibuprofen on free radical metabolism in human erythrocytes.

One of the major groups of chemical mediators involved in the inflammatory response is the prostaglandins, which are synthesized from arachidonic acid by the enzyme cyclooxygenase. The aim of this study is to compare the in vivo effects of celecoxib, meloxicam, and ibuprofen on the activities of catalase (CAT), glutathione peroxidase (GSHPx), superoxide dismutase (SOD) as well as malondialdehyde (MDA), and antioxidant potential levels (AOP) in human erythrocytes. Patients diagnosed as osteoarthritis were included in the study. Patients were treated with Celecoxib (200 mg/d) (n = 12), Meloxicam (15 mg/d) (n = 12), and Ibuprufen (1200 mg/d) (n = 9) for 21 days. SOD, CAT, GSHPx activities, MDA, and AOP levels were investigated in human erythrocyte haemolysates. SOD activity and AOP levels were significantly decreased in all NSAID groups when we compared the values before and after 21 days of celecoxib, meloxicam, ibuprofen treatment. There were no significant difference in CAT, GSHPx activities, and MDA levels before and after treatment in each group. Decreased SOD activities are thought to be related with the increased superoxide anion. Decreased AOP levels may indicate impairment in the total antioxidant defence system. These NSAIDs have similar effects on free radical metabolism on human erythrocytes; despite some difference in action mechanisms.

Pulmonary function tests, respiratory muscle strength, and endurance of patients with osteoporosis.

BACKGROUND: It has been shown that patients with thoracic kyphosis due to osteoporosis have diminished pulmonary function. The aim of this study was to determine the pulmonary function, respiratory muscle strength, and endurance of patients with osteoporosis who did not have compression fractures. METHODS: The patient group consisted of 88 recently diagnosed postmenopausal osteoporotic women without spinal fractures. They were matched for age and body mass index with 54 healthy women, who formed the control group. Bone mineral density, pulmonary function test (PFT), maximum voluntary ventilation (MVV), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP) measurements of both groups were performed. RESULTS: There were no significant differences between the two groups regarding PFT parameters and MIP and MEP. However, osteoporotic patients had significantly lower MW values. CONCLUSION: Women with postmenopausal osteoporosis without spinal compression fractures have normal PFT, MIP, and MEP values, but they have reduced respiratory muscle endurance.

Prevalence of dermatophytosis in patients with rheumatoid arthritis.

OBJECTIVE: The prevalence of dermatophytic infections in rheumatoid arthritis is unknown. This study investigated the prevalence of dermatophytosis in patients with rheumatoid arthritis and the relationship between sulfasalazine, low-dose methotrexate and steroid therapy. METHODS: We examined 53 consecutive patients with rheumatoid arthritis for evidence of dermatophytosis and compared them 55 with age- and sex-matched, nonimmunocompromised controls recruited from the low back pain population. Nail scrapings were obtained from the subjects, and the clinical diagnosis of dermatophytosis was confirmed with a potassium hydroxide preparation. RESULTS: In 32% of the rheumatoid arthritis population we found dermatophytosis, compared with 16% of the control group, although statistical significant was only borderline. Tinea pedis was the most frequent type of dermatophytosis in both groups. The prevalence of dermatophytosis in patients receiving sulfasalazine, low-dose methotrexate, and steroid therapy was not found to be significantly increased. CONCLUSIONS: This study shows a slightly higher prevalence of dermatophytosis in rheumatoid arthritis population than in controls. Sulfasalazine, low-dose methotrexate, and steroid therapy had no effect on the prevalence of dermatophytic infections in patients with rheumatoid arthritis.

Bone mineral density and grip strength in postmenopausal Turkish women with osteoporosis: site specific or systemic?

OBJECTIVE: To assess the relationship of grip strength to site-specific bone mineral density of the metacarpal bone and also axial bone mineral density. The bone mineral density of the lumbar spine, femoral neck and the nondominant hand were measured by DEXA. SUBJECTS: A total of 187 postmenopausal women were included in the study. Of the patients, 102 were osteoporotic, and 85 were not osteoporotic and served as control subjects. METHODS: Grip strength of the nondominant hand was measured by hand-held dynamometer. Skinfold thickness of the nondominant hand was measured by a caliper (Holstain). Biochemical markers of bone turnover and other osteoporosis-related variables were also measured. RESULTS: There was a statistically significant difference between groups regarding bone mineral density of the lumbar, femoral (neck) and hand regions and the grip strength (P < .05). Hand bone mineral density (BMD) was found to be correlated with bone mineral density of the lumbar and femoral (neck) regions in osteoporotic patients. Grip strength was correlated positively with the BMD of the nondominant hand. Grip strength was correlated negatively with age and years since menopause. Grip strength was also correlated positively with femoral neck BMD. CONCLUSION: The study provides support for a site-specific and also systemic relationship between muscle and bone. Grip strength is also a predictor of hand bone mineral density.

Behçet's syndrome coexisting with clinically occult ankylosing spondylitis.

The case of a 36-year old man with Behçet's disease (BS) for 16 years had low back pain and stiffness in the cervical and lumbar spine. He was diagnosed as having ankylosing spondylitis (AS). In this report we wish to emphasize the clinically occult co-existence of AS in BS and revelation of AS after a long time of BS diagnose.

Correlation of serum cytokine levels with axial bone mineral density.

Cytokine has been postulated to play a role in the pathogenesis of post-menopausal osteoporosis. To test this hypothesis we measured circulating levels of IL-1, IL-6,IL-8 and TNF-alpha in 98 post-menopausal women (30 age matched normal and 68 osteoporotic) with no vertebral fractures. Although the cytokine levels of patients were found in normal cut off values, the difference in cytokine levels between patients and controls was statistically significant for IL-1 and IL-8 (p < 0.01). In osteoporotic patients, none of the cytokines correlated with lumbar, femoral (neck) and total hip bone mineral densities and also with body mass index (p > 0.01). In conclusion, we were unable to demonstrate abnormalities of cytokines affecting bone resorption in peripheral serum of women with post-menopausal osteoporosis. However increased production of these cytokines may occur in the local environment of bone.