Demographic and clinical characteristics of inpatient stroke patients in Turkey.

Objectives: This study aims to assess the stroke rehabilitation facilities provided by university hospitals (UHs) and training and research hospitals (TRHs) and to evaluate the geographical disparities in stroke rehabilitation. Patients and methods: Between April 2013 and April 2014 a total of 1,529 stroke patients (817 males, 712 females; mean age: 61.7±14.0 years; range, 12 to 91 years) who were admitted to the physical medicine and rehabilitation clinics in 20 tertiary care centers were retrospectively analyzed. Demographic, regional and clinical characteristics, details of rehabilitation period, functional status, and complications were collected. Results: The median duration of stroke was five (range, 1 to 360) months. The ratio of the patients treated in the TRH in the Marmara region was 77%, but only 25% of the patients were living in the Marmara region. Duration of hospitalization was longer in the TRHs with a median of 28 days compared to those of UHs (median: 22 days) (p<0.0001). More than half of the patients (55%) were rehabilitated in the Marmara region. Time after stroke was the highest in the Southeast region with a median of 12 (range, 1 to 230) months and the lowest in the Aegean region with a median of four (range, 1 to 84) months. Conclusion: This study provides an insight into the situation of stroke rehabilitation settings and characteristics of stroke patients in Turkey. A standard method of patient evaluation and a registry system may provide data about the efficacy of stroke rehabilitation and may help to focus on the problems that hinder a better outcome.

Environmental characteristics of older people attending physical medicine and rehabilitation outpatient clinics.

OBJECTIVE: A residential environment refers to the physical and social characteristics in a neighbourhood. The physical characteristics include interior housing qualities, exterior neighbourhood characteristics, and the accessibility of essential facilities and services outside the neighbourhood. Older adults especially may be vulnerable to the negative impacts of the residential environment. The aim of this study is to elucidate the problems ageing people face in their neighbourhoods, buildings and public areas. METHODS: The study group consisted of a total of 1,001 people over the age of 65 who were admitted to physical medicine and rehabilitation clinics in Turkey and consented to participate. A questionnaire covering demographic, social and environmental information was used. RESULTS: Of the study group, 58.6% was living in an apartment building, but only 23.6% of these buildings had an elevator, and the stairs were inconvenient in 46.7% of the buildings. Only 49% of the elderly people went for a walk regularly. The most frequent complaint about the hospitals, community health centres and other public areas was the inappropriate restroom conditions. Eighty-six percent of the study group were not members of an organization, a foundation or a group, and 73.6% did not have personal hobbies. CONCLUSIONS: The layouts of buildings and surroundings are inappropriate for older people, and the opportunities for them to participate in social activities are limited. Health and social programmes and governmental and local policies for older people are needed, and public awareness about this issue should be raised.

Effects of whole-body vibration and high impact exercises on the bone metabolism and functional mobility in postmenopausal women.

INTRODUCTION: This study determined the effects of whole-body vibration (WBV) and high-impact exercises on postmenopausal women. MATERIALS AND METHODS: In this randomized controlled 6-month interventional trial, 58 eligible postmenopausal women were assigned to WBV training group, high-impact training group, or control group. Bone mineral density (BMD) of the lumbar spine and femur were measured by dual-energy X-ray absorptiometry. Additionally, the serum osteocalcin (OC) and C-terminal telopeptide of type I collagen levels were also measured. The functional mobility was assessed using the Timed Up and Go (TUG) test, and fall index was measured using static posturography. The health-related quality of life (HRQoL) and depressive symptoms were assessed using the Quality of Life Questionnaire of the European Foundation for Osteoporosis and Beck Depression Inventory, respectively. RESULTS: The BMD at the femoral neck (p = 0.003) and L2-L4 (p = 0.005) regions increased significantly in the WBV group compared to the control group. However, in the high-impact exercise group there were no significant effects on the lumbar spine and femoral neck. The serum OC decreased significantly in the WBV group and increased significantly in both the high-impact exercise and control groups (p < 0.001). The TUG scores decreased significantly in both training groups compared to the control group (p < 0.05). Finally, in both exercise groups, HRQoL and depressive symptoms improved (p < 0.001). CONCLUSIONS: Our data suggest that the WBV can prevent bone loss in postmenopausal women. These findings also indicate that WBV and high-impact training programs improve functional mobility, HRQoL and depressive symptoms in postmenopausal women.

2017 update of the Turkish League Against Rheumatism (TLAR) evidence-based recommendations for the management of knee osteoarthritis.

In a Turkish League Against Rheumatism (TLAR) project, evidence-based recommendations for the management of knee osteoarthritis (OA) was developed for the first time in our country in 2012 (TLAR-2012). In accordance with developing medical knowledge and scientific evidence, recommendations were updated. The committee was composed of 22 physical medicine and rehabilitation specialists (4 have rheumatology subspeciality also) and an orthopaedic surgeon. Systematic literature search were applied on Pubmed, Embase, Cochrane and Turkish Medical Index for the dates between January the 1st 2012 and January the 29th of 2015. The articles were assessed for quality and classified according to hierarchy for the level of evidence, and the selected ones sent to committee members electronically. They were asked to develop new recommendations. In the meeting in 2015, the format of the recommendations was decided to be patient-based and considering the grade and the severity of the disease. By the discussion of the each item under the light of new evidences, the final recommendations were developed. Each item was voted electronically on a 10-cm visual analogue scale (VAS) and the strength of recommendation (SoR) was calculated. In the light of evidences, totally 11 titles of recommendations were developed; the first 7 were applicable to each patient in every stages of the disease, remaining were for defined specific clinical situations. The mean SoR value of the recommendations was between 7.44 and 9.93. TLAR-2012 recommendations were updated in a new format. We think that, present recommendations will be beneficial for the physicians who manage, as well as the patients who suffer from the disease.

A Multicenter Pilot Study of Burden Among Caregivers of Geriatric Rehabilitation Patients With Neuromusculoskeletal Diseases.

PURPOSE: In this study, we aimed to describe the sociodemographic characteristics of caregivers of patients in a geriatric unit and to clarify the relationship between caregiver burden and specific clinical variables in the patients and the characteristics of the caregivers. DESIGN: Cross-sectional multicenter study. METHODS: One hundred twenty-three patients and 123 caregiver dyads, with mean ages of 72.5 ± 7.7 years and 51 ± 14.7 years, respectively, were included. The functional, psychological, and cognitive statuses of the patients were determined, and the sociodemographic characteristics of the caregivers as well as the type and duration of caregiving were recorded. Caregivers completed the Caregiver Burden Inventory (CBI) to measure the perceived burden of care. Most patients were female and generally lived with their family. FINDINGS: Most of the caregivers were family members (90%), female (73.2%), primary school graduates (52.8%), and first-degree relatives (73.1%). The average CBI score was 33, and the highest CBI subscores were for time, developmental, and physical burdens. Caregiver burden correlated with the patient's ambulatory, psychological, and cognitive status and with the caregiver's age, gender, income level, and duration of caregiving. CONCLUSIONS: We have highlighted the relationship between caregiver and patient characteristics in a cohort of elderly Turkish patients with neurological and musculoskeletal disorders. In particular, we have highlighted the heavy caregiver burden in a developing country. CLINICAL RELEVANCE: Our results may guide the nurses to understand the requirements of caregivers and to help them find suitable resources that would meet their needs to cope with their burden.

Influence of patient training on persistence, compliance, and tolerability of different dosing frequency regimens of bisphosphonate therapy: An observational study in Turkish patients with postmenopausal osteoporosis.

OBJECTIVE: In our study, we aimed to evaluate the influence of training on compliance and persistence with bisphosphonate treatment given on a weekly vs. monthly basis in postmenopausal osteoporosis patients. METHODS: A total of 979 patients with postmenopausal osteoporosis (mean age: 63.2 ± 7.2 years) were included in this national, multicenter, prospective non-interventional observational cohort registry study. Patients were randomized into training (n = 492, 50.3%, mean age: 63.4 ± 7.2 years) and control (n = 487, 49.7%, mean age: 63.0 ± 7.1 years) groups. Patients in each intervention group were given weekly (44.9% and 44.6% for training and control subjects, respectively) or monthly (55.1% and 55.4%, respectively) bisphosphonate regimens. After the initial visit, patients were followed up at three-month intervals throughout 12 months of treatment for evaluation of persistence, compliance and adverse events. RESULTS: On average, 79.4% of the patients were persistent with the treatment with a mean of 350.4 days of duration during the 12-month follow-up period. The mean compliance in the compliant and fully compliant group remained at an average of 86.6%. No significant difference was detected between the training and control groups in terms of compliance and persistence. Significantly longer persistence (360.0 ± 89.0 vs. 345.0 ± 108.0 days; p = 0.035), higher percentage of persistent patients (83.4% vs. 74.2%; p = 0.012) and higher compliance rates (88.8% vs. 83.3%; p = 0.002) were noted in monthly regimen patients in comparison to those given weekly regimen. CONCLUSION: Our findings revealed remarkably high rates for persistence and compliance with bisphosphonate treatment in postmenopausal osteoporosis, with no impact of training on compliance and persistence rates. Longer persistence and better compliance rates were achieved with the monthly bisphosphonate regimen when compared to the weekly regimen.

Investigating the effectiveness of postural muscle electrostimulation and static posturography feedback exercises in elders with balance disorder.

BACKGROUND: Deterioration associated with aging in the erect posture and balance to change the location of the center increased the rate of fall in older age is one of the reasons. Loss of muscle strength is one of the major factors affecting the posture. In this prospective, randomized and controlled study, it was aimed to investigate the effectiveness of strengthening postural muscles through electrostimulation or by applying biofeedback exercises with static posturography in patients aged 60 years and over with balance disorder. METHODS: Patients aged between 60-80 years, who applied to Istanbul Faculty of Medicine Physical Medicine and Rehabilitation Department outpatient clinic and had been diagnosed with balance disorder using the Timed Up and Go (TUG) test, were included. 250 patients were screened, from them 67 patients were enrolled and 57 of them completed the study. Patients were randomized to three groups. The patients in Tetrax® group (TG) group (n:18) participated in a 15-minute exercise with Tetrax® which consisted of 15 minutes exercise session 3 times weekly for 4 weeks. The patients in EG group (n:19) received an electrostimulation program of postural muscles of 40 minutes per session 3 times weekly for 4 weeks. Patients in the control group (n:20) did 6-week balance exercises which were performed by other groups as well. 48 out of 57 patients attended the 6th-month control. As determinants of balance status Timed Up and Go Test (TUG), Berg Balance Scale (BBS) and Fall Index measured by Tetrax® were calculated at baseline, 1-month and 6-month follw up assesments. The patient's quality of life was assesed by Turkish version of World Health Organisation Quality of Life Questionnaire in Older Adults (WHOQOL-OLD.TR) at baseline and 6-month follow up assesments. RESULTS: TUG values in both EG and TG decreased significantly between baseline assesment and 1-month (mean differences for TG: -4,00 ± 1,309 and EG -2,588 ± 1,839 p= 0,002 for the each of groups) and baseline assesment and 6-month (mean differences for TG: -2,933± 1,223 and EG -2,058 ± 1,477 p= 0,003 for the each of groups). A significant increase was determined in BBS values between baseline and 1-month (mean differences for TG: 4.000 ± 2,360 and EG: 3,529 ± 2,672 p= 0,031 for the each of groups). Fall Index (FI) measured by Tetrax® decreased between baseline assesment and 1-month (p= 0,185), and 6-month (p= 0,086) respectively, also between 1-month and 6-month follow up assesments (p= 0,627), but all of them were not significant changes. In all three groups the quality of life (p= 0,951) improved. Exercises conducted with Tetrax® were more effective than electrostimulation of postural muscles in increasing TUG values and decreasing BBS values. CONCLUSIONS: Even though applying electrostimulation to postural muscles affected patients positively compared to pre-treatment, exercises performed with Tetrax® were more effective than the electrostimulation protocol to postural muscles in reducing balance disorder and this well-being continued even in the 6th month.

Osteoporotic risk and physeal closure in prepubertal ovariohysterectomized cats.

We aimed to examine the early effects of prepubertal ovariohysterectomy (P-OHE) on bone loss and proximal physeal closure in cats. Fourteen kittens randomly underwent P-OHE or sham operations (S-OP) at three months (mo) of age and were allocated to group I and group II. Each mo between four and nine mo of age, dual-energy X-ray absorptiometry (DEXA) scans were performed to determine the total body bone mineral density (BMD) and bone mineral content (BMC). Proximal radial physeal closure and radial length were determined by radiography. Bone-specific alkaline phosphatase (BAP), carboxy-terminal collagen teleopeptide (CTX), 17-ß estradiol, progesterone, calcium (Ca) and phosphorus (P) were measured in the serum samples. No significant differences were observed between the groups in terms of BMD, BMC, BAP, BAP/CTX, P, progesterone and body weight (BW) (between 4 and 9mo) and for Ca (between 5 and 9mo) and for CTX levels (between 4 and 8mo). The 17-ß estradiol was significantly higher at 6, 8 and 9mo of age in the S-OP group due to puberty (P=0.02, P=0.03 and P=0.02 respectively). Although there was a significant difference (P=0.0002) between the P-OHE and S-OP groups in terms of the proximal radial physeal closure times (7.43±0.20mo and 6.14±0.14mo, respectively), no significant difference was observed for the mean radius length (10.59±0.10cm and 10.06±0.27cm, respectively) at the last evaluation time. In conclusion, prepubertal ovariohysterectomized cats do not have any osteoporotic risks until nine mo of age and exhibit a delayed physeal closure time without a change in radius length.

Impact of the training on the compliance and persistence of weekly bisphosphonate treatment in postmenopausal osteoporosis: a randomized controlled study.

Long-term patient adherence to osteoporosis treatment is poor despite proven efficacy. In this study, we aimed to assess the impact of active patient training on treatment compliance and persistence in patients with postmenopausal osteoporosis. In the present national, multicenter, randomized controlled study, postmenopausal osteoporosis patients (45-75 years) who were on weekly bisphosphonate treatment were randomized to active training (AT) and passive training (PT) groups and followed-up by 4 visits after the initial visit at 3 months interval during 12 months of the treatment. Both groups received a bisphosphonate usage guide and osteoporosis training booklets. Additionally, AT group received four phone calls (at 2(nd), 5(th), 8(th), and 11(th) months) and participated to four interactive social/training meetings held in groups of 10 patients (at 3(rd), 6(th), 9(th), and 12(th) months). The primary evaluation criteria were self-reported persistence and compliance to the treatment and the secondary evaluation criteria was quality life of the patients assessed by 41-item Quality of Life European Foundation for Osteoporosis (QUALEFFO-41) questionnaire. Of 448 patients (mean age 62.4±7.7 years), 226 were randomized to AT group and 222 were randomized to PT group. Among the study visits, the most common reason for not receiving treatment regularly was forgetfulness (54.9% for visit 2, 44.3% for visit 3, 51.6% for visit 4, and 43.8% for visit 5), the majority of the patients always used their drugs regularly on recommended days and dosages (63.8% for visit 2, 60.9% for visit 3, 72.1% for visit 4, and 70.8% for visit 5), and most of the patients were highly satisfied with the treatment (63.4% for visit 2, 68.9% for visit 3, 72.4% for visit 4, and 65.2% for visit 5) and wanted to continue to the treatment (96.5% for visit 2, 96.5% for visit 3, 96.9% for visit 4, and 94.4% for visit 5). QUALEFFO scores of the patients in visit 1 significantly improved in visit 5 (37.7±25.4 vs. 34.0±14.6, p<0.001); however, the difference was not significant between AT and PT groups both in visit 1 and visit 5. In conclusion, in addition to active training, passive training provided at the 1(st) visit did not improve the persistence and compliance of the patients for bisphosphonate treatment.

The effects of strengthening and high-impact exercises on bone metabolism and quality of life in postmenopausal women: a randomized controlled trial.

BACKGROUND AND OBJECTIVE: The aim of this prospective, randomized controlled 6-month interventional trial was to investigate the effects of strengthening and high-impact exercise training on bone mineral density (BMD), bone turnover markers and health-related quality of life (HRQoL) in postmenopausal women. MATERIAL AND METHODS: Forty-two eligible postmenopausal women with osteopenia who referred to our outpatient clinics were included in the study and allocated equally to three groups receiving strengthening exercise, high-impact exercise or no exercise (control). The supervised training program consisted of a one-hour exercise session three times a week for six months. BMD at the L1-L4 and femoral neck, serum bone turnover markers (osteocalcin, OC; N-telopeptides of type I collagen, NTx) and HRQoL were measured at the beginning and sixth months. RESULTS: There was a significant increase in the BMD at the lumbar spine (p=0.017) and femoral neck (p=0.013) in the high-impact group compared to the strengthening and control groups. Serum OC (p=0.033) increased, and NTx (p=0.034) decreased significantly only in the high-impact group. HRQoL improved significantly in both training groups (p< 0.001). CONCLUSIONS: Our data suggest that 6-month supervised high-impact exercise training can be effective in prevention of bone loss at lumbar spine and femoral neck. These data also indicate that both supervised training programs improve HRQoL in postmenopausal women.

Vaginal cone therapy in patients with stress urinary incontinence.

PURPOSE: The aim of this study is to assess the effectiveness of the vaginal cone usage in patients with stress urinary incontinence (SUI) treated by hormone replacement therapy (HRT). METHODS: In this prospective controlled study, vaginal cone therapy is proposed to 22 postmenopausal patients with SUI having HRT who were admitted to Istanbul University, Faculty of Medicine Urogynecology Division. The vaginal cone therapy protocol consisted of one 40-min session per day over a 12-week period at standing position, and to push back the vaginal cone if they feel it slide for 15 times. Control group consisted of ten postmenopausal patients receiving only HRT. For the two groups, perineometry value, pad test, and 3 days average number of incontinence were assessed at the beginning and after 2 months of treatment. RESULTS: In the vaginal cone group, in all parameters a statistically significant difference was observed toward improvement as compared to baseline (p < 0.01); there were no significant differences (p > 0.05) in the HRT group. While comparing between the mean differences of two groups, the average number of urinary leakage was decreased and perineometry value was statistically increased (t = 3.74, p < 0.001; t = 3.24, p < 0.01) in vaginal cone group rather than in the HRT group which was calculated from the urinary diary. CONCLUSIONS: Vaginal cone could be an effective method of treatment in patients with SUI and may be a preferable treatment for patients who have problem to come to hospital and want to work independently at home.

The impact of a FRAX-based intervention threshold in Turkey: the FRAX-TURK study.

INTRODUCTION: With the development of country-specific FRAX® tools to estimate fracture probability, guidance is required on the fracture probability at which treatment can be recommended. OBJECTIVES: The aim of the present study was to determine FRAX-based intervention thresholds in men and women from Turkey and determine their population impact. PATIENTS AND METHODS: Intervention thresholds for treatment and assessment thresholds for measuring BMD were devised using the strategy adopted by the National Osteoporosis Guideline Group of the UK but applied to the fracture probabilities in Turkey. The number of men and women potentially eligible for treatment was determined from the distribution of FRAX-based probabilities of a major fracture (Turkish model, version 3.6) in a representative sample of 26,394 men and women aged 50 years or more. RESULTS: Intervention thresholds, set at the probability equivalents of a woman with a prior fragility fracture rose with age from 7.0 % at the age of 50 years to 31 % at the age of 90 years. Approximately 8.6 % of the female Turkish population aged 50 years or more had a prior fragility fracture and would be eligible for treatment. A further 13.6 % without a prior fracture would be eligible for treatment. In contrast, the number of men aged 50 years or more eligible for treatment was 3.1 %. CONCLUSIONS: FRAX-based guidelines can be developed and are expected to avoid unnecessary treatment of individuals at low fracture risk and direct treatments to those at high risk. The adoption of FRAX-based intervention thresholds will demand a reappraisal of the criteria for reimbursement of interventions and health economic assessment.

Is There a Relationship between Vitamin B12 and Stress Urinary Incontinence?

OBJECTIVE: Pelvic floor, which includes collagen, elastin, and smooth muscle, is very important in preventing urinary incontinence (UI). Studies suggest that vitamin B12 is involved in collagen synthesis. In the present study we aimed to determine the association of vitamin B12 deficiency with stress UI in a sample of Turkish women. METHODS: Forty-two women with stress UI or mixed UI who met the inclusion criteria from a group of 541 women with stress UI or mixed UI, were included in the study. The study group was compared with a control group of 20 healthy women without UI who matched to the study group's demographic data and met the inclusion criteria. Demographic data as well as duration of symptoms and vitamin B12 levels were analyzed and compared. RESULTS: The mean ages of the study and the control groups were 50.04 ± 4.6 and 49.02 ± 5.1 years, respectively. Vitamin B12 level was 300.95 ± 142.9 pg/mL in the study group, whereas in the control group it was 598.98 ± 120.3 pg/mL (P < 0.001). In the study group, 66.6% of the patients with stress UI had vitamin B12 levels less than 300 pg/mL. When the duration of symptoms and vitamin B12 levels were compared, women with vitamin B12 levels less than 200 pg/mL had symptoms for a longer duration (P < 0.01). CONCLUSION: One of the main etiologic factors for stress UI is a defect in pelvic floor support. Vitamin B12 is lower in women with stress UI. Analysis of vitamin B12 levels should also be considered in the evaluation of women with stress UI.

Adiponectin is an indicator of insulin resistance in non-obese prepubertal children born large for gestational age (LGA) and is affected by birth weight.

BACKGROUND AND OBJECTIVE: Being born as large for gestational age (LGA) has an increased risk of developing insulin resistance. Hypoadiponectinaemia is associated with insulin resistance. The aim of this study was to evaluate adiponectin levels and insulin resistance in association with body composition in LGA born non-obese children at prepubertal ages. PATIENTS AND METHODS: Thirty-five (17 female and 18 male) LGA born non-obese children (mean age 4.8 +/- 0.3 years) were evaluated with respect to glucose, insulin, IGFBP-1, leptin, adiponectin levels and body composition by DEXA. Their data were compared to that of non-obese 49 (20 female, 29 male) appropriate for gestational age (AGA) children (mean age 3.8 +/- 0.1 year). RESULTS: LGA children, who had similar body mass index standard deviation scores (BMI SDS) as AGA children, had significantly higher insulin (P = 0.043) and statistically borderline significant homeostasis model assessment-insulin resistance (HOMA-IR) levels (P = 0.054) than those of AGA children. Adiponectin levels were significantly lower in LGA than AGA children (P = 0.004) even after controlling for age, sex and BMI (P = 0.016). IGFBP-1, leptin levels and body composition did not show a difference. When the LGA group was divided into subgroups according to birth weight, the analysis revealed that after controlling for BMI, being an LGA and having a higher birth weight in the upper half were associated with lower adiponectin levels (estimated marginal means of logarithmic adiponectin levels 2.6 +/- 0.2 vs. 2.1 +/- 0.2 microg/ml, P = 0.042). CONCLUSION: LGA children have higher insulin and lower adiponectin levels than AGA children in spite of similar BMI. Adiponectin is a better indicator of insulin resistance in LGA children at prepubertal ages and is affected by birth weight.

Insulin resistance and body composition in preterm born children during prepubertal ages.

BACKGROUND: Premature born children may show insulin resistance in childhood which may be due to intrauterine or postnatal adverse environmental factors. OBJECTIVE: Aim of this study was to evaluate insulin resistance and body composition in preterm born children born appropriate for gestational age (AGA) or small for gestational age (SGA) and relations with IGF-I, IGFBP-3 axis. METHODS: Ninety-three preterm born children grouped as premature SGA (n = 30) and premature AGA (n = 63) were evaluated at age 4.6 +/- 0.2 years and 4.7 +/- 0.1 years with respect to their glucose, insulin, IGF-I, IGFBP-3, IGFBP-1, leptin levels and body composition by dual-energy X-ray absorptiometry. Their data were compared to that of body mass index (BMI) matched term SGA (n = 42) and term AGA (n = 44) children of age 4.5 +/- 0.2 and 3.8 +/- 0.1 years. All children had height appropriate for their target height. Insulin resistance was evaluated by basal insulin and homeostasis model assessment for insulin resistance (HOMA-IR). RESULTS: Basal insulin level was similar in preterm AGA (4.3 +/- 1.4 pmol/l) and term AGA (7.9 +/- 6.4 pmol/l) children at similar and normal BMI levels. Preterm SGA children had insulin levels (5.0 +/- 3.6 pmol/l) similar to preterm AGA children but significantly lower than that in term SGA children (23.7 +/- 20.8 pmol/l) (P = 0.001). Similar results were obtained for HOMA-IR. Term SGA children had also significantly lower IGFBP-1 levels. Body composition, leptin and IGFBP-3 did not differ between the respective groups. IGF-I was lower in preterm AGA (5.0 +/- 0.6 nmol/l) than in term AGA (8.3 +/- 1.2 nmol/l) (P < 0.001) children. CONCLUSIONS: Premature born AGA and SGA children do not have insulin resistance when compared to term children if they have made a catch-up growth appropriate for their target height and have normal BMI. The similar insulin levels in preterm SGA and preterm AGA children together with increased insulin levels in term SGA children points to the fact that it is the intrauterine restriction in the third trimester that has an adverse effect on future adverse metabolic outcome.

Insulin, adiponectin, IGFBP-1 levels and body composition in small for gestational age born non-obese children during prepubertal ages.

BACKGROUND: Being small for gestational age (SGA) at birth and postnatal growth pattern may have an impact on insulin resistance and body composition in later life. Adiponectin is a strong determinant of insulin sensitivity. OBJECTIVE: The aim of this study was to evaluate insulin resistance and adiponectin levels in SGA born children with catch-up growth (CUG) in the absence of obesity in prepubertal ages and relations with body composition and insulin-like growth factor binding protein (IGFBP)-1. METHODS: Twenty-four (15F, 9M) SGA born children with CUG but without obesity were evaluated at age 6.3 +/- 0.5 years with respect to glucose, insulin, IGFBP-1, leptin and adiponectin levels, and body composition by dual-energy X-ray absorptiometry (DEXA). Their data were compared to that of 62 (27F, 35M) appropriate for gestational age (AGA) children. RESULTS: SGA and AGA children had similar height standard deviation score (SDS) corrected for parental height and body mass index (BMI) SDS. Homeostasis model for insulin resistance (HOMA-IR) was significantly high in SGA (0.7 +/- 0.6) than in AGA children (0.4 +/- 0.2) (P = 0.029). There were no significant differences in leptin, IGFBP-1, adiponectin, and total and truncal fat between SGA and AGA children. However, being born SGA and having higher BMI in the upper half for the distribution in the sample, although within normal ranges, was associated with lower adiponectin levels (estimated means of log adiponectin levels 3.8 +/- 0.3 vs. 4.4 +/- 0.1 microg/ml, P = 0.040). CONCLUSIONS: SGA children with CUG and with no obesity have higher insulin levels compared to AGA children. Both SGA birth and recent size seem to have an effect on serum adiponectin levels in childhood.

Bone mineral density in children with neurofibromatosis 1.

AIM: Our aim was to detect the status of bone mineral density (BMD) in children with NF1, and thus to help the management of the skeletal complications of NF1. METHODS: Dual-energy X-ray absorptiometry (DEXA) was performed in lumbar spine, total body, proximal femur and forearm in 31 children (3.1-18 years) with NF1. Correlations among the BMD values of four regions were calculated statistically. Z-scores of lumbar- and total body-BMD were also evaluated in 24 patients at and older than 5 years. RESULTS: Eleven children had skeletal findings, including mild scoliosis in 5 patients. No case with total body-Z score <-2 was detected. Lumbar-Z score was lower than -2 in 3 out of 24 cases. Patients with any skeletal involvement of NF1 were likely to have a lumbar-BMD lower than -2 in comparison with patients with no skeletal finding (odds ratio 4; 95% CI 0.01-4.62). Proximal femur-BMD values (g/cm(2)), yet forearm-BMDs, were correlated with both lumbar- and total body-BMD, regardless of skeletal involvements of NF1. CONCLUSIONS: Our findings suggest that lumbar- or proximal femur-DEXA, rather than forearm- or total body-DEXA, could reveal significantly decreased BMD in children with NF1, especially in those with skeletal involvement of NF1.

Quantitative calcaneal ultrasonometry: normative data and age-related changes for stiffness index in the Turkish population.

The aim of this cross-sectional study was to define the normative data for stiffness index in a large sample of Turkish population and to clarify sex differences as well as age-related changes. A total of 10,435 subjects (aged 18-89 yr) were screened with calcaneal ultrasound and were requested to complete a detailed questionnaire listing all important risk factors, diseases, and treatments affecting bone metabolism. To be included in the study, subjects had to be free of any disease and any medical treatment known to affect bone metabolism. A total of 8,156 subjects (1,389 males and 6,767 females) were included in the study. Normative data was expressed using two statistical models including mean and 95th percentile, and regression analysis. The mean value of stiffness index in females peaked in the third decade, whereas in males it peaked in the age group of 18-29 yr. The stiffness index of females decreased by 24.26%. The total age-related decrease was 17.8% for stiffness index in the males. Stiffness index in males was a function of age (negatively) and body mass index (positively). Stiffness index in females was a function of age (negatively) and weight (positively). The results of this study could be useful as a guide for comparing the data of individual studies and may serve as reference normative data for the Turkish population.

Hypermobility syndrome in 105 women with pure urinary stress incontinence and in 105 controls.

We compared the frequency of Hypermobility Syndrome (HS) in 105 patients with urinary stress incontinence (USI) with the frequency of HS in 105 healthy controls that matched for age and parity. A Beighton score (BS) of more than 3 was used to make the clinical diagnosis of HS. Thirty-six patients (34.28%) from the USI group and 28 patients (26.66%) from the control group were diagnosed as HS. The mean BS values were 6.44+/-0.35 and 5.21+/-0.29 respectively. The difference between the two groups was statistically significant ( P<0.05).