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INTRODUCTION: The purpose of this study was to determine whether the pan-immune-inflammation value (PIV), a novel biomarker combining neutrophil platelet, monocyte, and lymphocyte counts, some of the most widespread indicators of systemic inflammation, can predict mortality and prognosis in patients admitted to the intensive care unit (ICU) with septic shock. METHOD: This prospective study was performed with 82 patients aged 18 or over admitted to a tertiary ICU with diagnoses of septic shock. Patients with hematological disease and neutropenia were excluded. PIV was calculated with the formula [neutrophil count (103/µL) × platelet count (103/µL) × monocyte count (103/µL)]/lymphocyte count (103/µL). RESULTS: Median age, presence of hypertension, Acute Physiology and Chronic Health Evaluation II (APACHE II) levels, and neutrophil, monocyte, and platelet counts were lower in the low-PIV group than in the high-PIV group (p < 0.05). The highest area under ROC curve (AUC) was determined for Sequential Organ Failure Assessment (SOFA) (0.94 (0.89 - 0.99)), followed by Glasgow Coma Scale (GCS) (0.81 (0.70 - 0.91)), APACHE II (0.80 (0.69 - 0.91)) and lactate (0.77 (0.67 - 0.88)). Median survival was longer in the low-PIV group than in the high-PIV group (28 (15.25 - 40.76) vs 16 (9.46 - 22.55) days, respectively, p < 0.05). The univariate Cox proportional hazards (CPH) model showed that high PIV (HR = 2.13 (1.03-4.38)), low GCS (HR = 3.31 (1.34 - 8.15)), high SOFA (HR = 9.41 (2.86 - 30.95)), high APACHE II (HR = 3.08 (1.47 - 6.45)), high lactate (HR = 6.56 (2.73 - 15.75)), and high procalcitonin (PCT) (HR = 2.73 (1.11 - 6.69)) values were associated with a decreased survival time among ICU patients (p < 0.05). The multivariate CPH model showed the age-adjusted risk estimates for these six laboratory parameters. High lactate (HR = 7.97 (2.19 - 29.08)) and high SOFA scores (HR = 4.85 (1.22 - 19.32)) were significantly associated with shorter survival in ICU patients (p < 0.05). CONCLUSION: The findings of this research suggest that PIV could predict the longer survival in patients with septic shock. Despite PIV score's capability to show inflammation, it is not significantly associated with mortality in the multivariate analysis.
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Choque Séptico , Humanos , Prognóstico , Estudos Prospectivos , Inflamação , Ácido LácticoRESUMO
INTRODUCTION: Sepsis and septic shock are disorders of tissue perfusion and microcirculation associated with increased mortality. The role of biomarkers such as proadrenomedullin (PRO-ADM), interleukin 6 (IL-6) and neutrophil CD64 (CD64) in the diagnosis and prognosis of septic shock has been studied. METHODS: GCS, SOFA score, APACHE 2 score, lactate, CRP, procalcitonin, PRO-ADM, IL-6, CD64 level and 28-day mortality were evaluated in patients with septic shock followed-up in the intensive care unit of Marmara University Hospital between July 2021 and December 2021. The study was planned as prospective, non-drug clinical research Committee. RESULTS: There were no statistically significant differences between patient groups in gender, BMI, and presence of comorbidities (p > 0.05). The alive patient group had significantly higher GCS values and lower SOFA, APACHE 2, lactate and CD64 values than the dead patient group (p < 0.01). The cut-off values of laboratory parameters were determined using ROC analysis to predict mortality, SOFA and CD64 had high AUC. This is also a good indicator for mortality.The multivariate logistic regression model was estimated using the backward selection method. The mortality of ICU patients was predicted by a SOFA-value ≥ 12 (OR (95%CI) = 56.13 (5.44-578.64)), CD64 value ≥ 28.54 (OR (95% CI) = 23.78 (2.61-216.85)), and ADM-value ≥ 86.79 (OR (95% CI) = 15.86 (1.02-246.49)) (p < 0.05) . CONCLUSION: In conclusion, serum CD64 level, PRO-ADM level, and SOFA score proved to be effective parameters for predicting prognosis and mortality in septic shock. However, IL-6 proved to be a weak biomarker and failed to predict mortality. CD64, which is easier and more practical to use, can be used instead of the SOFA score.
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Interleucina-6 , Choque Séptico , Humanos , Choque Séptico/diagnóstico , Estudos Prospectivos , Prognóstico , Ácido LácticoRESUMO
OBJECTIVE: To evaluate the role of intermittent pneumatic compression in the treatment of breast cancer-related lymphoedema. DESIGN: Randomized controlled trial. SETTING: Physical medicine and rehabilitation clinic at a university hospital. SUBJECTS: Seventy-six patients with lymphoedema. INTERVENTIONS: Patients were allocated into Group 1 (complex decongestive treatment, n = 38) and Group 2 (complex decongestive treatment + intermittent pneumatic compression, n = 38). The complex decongestive treatment involved skin care, manual lymphatic drainage, compression bandaging, and exercise for 20 sessions. Group 2 additionally received intermittent pneumatic compression. MAIN MEASURES: Quantitative outcomes consisted of volumetric measures prior to and after the treatment. Clinical assessments included severity of pain, heaviness and tightness, disability, grip strength, and depression. RESULTS: Lymphoedema was similar at baseline, but treatments significantly reduced the excess volume (from 373 mL to 203 mL in Group 1 and 379.5 mL to 189.5 mL in Group 2). Percentage excess volumes (PEVs) decreased in both groups. The percentage reduction of excess volume was better in Group 2 than Group 1, but the intergroup difference was not significant. The clinical scores reflected improvements, but the heaviness and tightness read significantly lower in Group 2 than Group 1. CONCLUSION: Intermittent pneumatic compression seems to add no benefit when combined with complex decongestive treatment of lymphoedema, but, may be functional in reducing the sensations of heaviness and tightness for the patients with pitting oedema.
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Neoplasias da Mama/complicações , Dispositivos de Compressão Pneumática Intermitente , Linfedema/terapia , Adulto , Bandagens Compressivas , Depressão/etiologia , Avaliação da Deficiência , Drenagem , Terapia por Exercício , Feminino , Força da Mão , Humanos , Linfedema/etiologia , Masculino , Pessoa de Meia-Idade , Escala Visual AnalógicaRESUMO
This study aimed to perform genicular nerve RF neurotomy using two different imaging methods, fluoroscopy and ultrasound, and to compare the clinical effects and reliability of the two methods. Fifty patients with osteoarthritis were included in this study. Patients were randomly allocated into group 1 (fluoroscopy imaging) and group 2 (ultrasound imaging). Outcomes were measured using a pain scale (visual analog scale; VAS) and the Western Ontario and McMaster Universities (WOMAC) Index of Osteoarthritis. The application time in the ultrasound group (20.2 ± 6.4 min) was shorter than in the fluoroscopy group (25 ± 4.8 min) (p < 0.05). There was no difference in pain relief and functional status between the ultrasound and fluoroscopy groups. Decrease in VAS score and WOMAC total score in the first and third months was significant in both groups (p < 0.001). GNRFT under ultrasound guidance was easily applicable, safe and dynamic, and required no radiation to achieve the same benefit as the fluoroscopy-guided interventions.
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Denervação , Eletrocoagulação , Fluoroscopia , Joelho/inervação , Osteoartrite do Joelho/terapia , Ultrassonografia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Articulação do Joelho , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso , Osteoartrite do Joelho/fisiopatologia , Manejo da Dor , Medição da Dor , Estudos Prospectivos , Ondas de Rádio , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Resultado do Tratamento , Escala Visual AnalógicaRESUMO
[Purpose] Physiotherapeutic heating agents are classified into two groups: superficial-heating agents and deep-heating agents. Therapeutic ultrasound is a deep-heating agent used to treat various musculosketal disorders. Numerous studies have attempted to determine the impact of ultrasound on healthy nerve conduction parameters. However, the instantaneous effects of deep heating via ultrasound on demyelinating nerves do not appear to have been described previously. The present study aimed to assess and compare the impact of ultrasound on demyelinating nerve and healthy nerve conduction parameters. [Subjects and Methods] Carpal tunnel syndrome was used as a focal demyelination model. Thirty-two hands of 25 participants with carpal tunnel syndrome were enrolled in the study. Ultrasound parameters were 3.3â MHz, 1.0â W/cm(2), 8 minutes, and continuous wave. Electrodiagnostic studies were performed initially, at the midpoint (4th min), and immediately after (8th min) ultrasound application. [Results] Reduced motor conduction velocity was found in demyelinating nerves at the 4th and 8th minutes. Ulnar nerve onset latency was significantly prolonged in the 8th minute recording, compared to the initial value. There were no significant differences in relative velocity and latency changes between demyelinating and normal nerves. [Conclusion] Deep heating via ultrasound may inversely affect conduction velocity in demyelinating nerves.
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This double-blind, randomized controlled study was conducted with the aim to investigate the effect of magnetic field therapy applied to the hip region on clinical and functional status in ankylosing spondylitis (AS) patients. Patients with AS (n = 66) who were diagnosed according to modified New York criteria were enrolled in this study. Patients were randomly divided in two groups. Participants were randomly assigned to receive magnetic field therapy (2 Hz) (n = 35), or placebo magnetic field therapy (n = 31) each hip region for 20 min. Patients in each group were given heat pack and short-wave treatments applied to bilateral hip regions. Both groups had articular range of motion and stretching exercises and strengthening exercises for surrounding muscles for the hip region as well as breathing and postural exercises by the same physical therapist. These treatment protocols were continued for a total of 15 sessions (1 session per day), and patients were examined by the same physician at months 1, 3 and 6. Visual analogue scale (VAS) pain, VAS fatigue, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrologic Index (BASMI), DFI, Harris hip assessment index and Ankylosing Spondylitis Quality of Life scale (ASQOL) were obtained at the beginning of therapy and at month 1, month 3 and month 6 for each patient. There were no significant differences between groups in the VAS pain, VAS fatigue, morning stiffness, BASDAI, BASFI, BASMI, DFI, Harris hip assessment index and ASQoL at baseline, month 1, month 3 or month 6 (p > 0.05). Further randomized, double-blind controlled studies are needed in order to establish the evidence level for the efficacy of modalities with known analgesic and anti-inflammatory action such as magnetotherapy, particularly in rheumatic disorders associated with chronic pain.
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Articulação do Quadril , Magnetoterapia , Espondilite Anquilosante/fisiopatologia , Espondilite Anquilosante/terapia , Adulto , Método Duplo-Cego , Feminino , Articulação do Quadril/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Modalidades de Fisioterapia , Qualidade de Vida , Amplitude de Movimento Articular/fisiologia , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do TratamentoRESUMO
The aim of our study was to investigate the frequency of the metabolic syndrome in chronic low back pain and evaluate the differences in clinical and functional parameters in chronic low back pain patients with and without metabolic syndrome. Patients complaining of low back pain complaint lasting for at least 2 months were included in the study. In order to establish functional deficiency, Roland-Morris Disability Questionnaire, Istanbul Low Back Pain Disability Index and Oswestry Disability Index were used. To evaluate depression, Beck's depression scale was used. The diagnosis of metabolic syndrome was made according to the criteria of National Cholesterol Education Program (NCEP) defined in 2001. For this; lumbar circumference around anterior iliac spine, arterial blood pressure, fasting blood glucose, plasma triglyceride levels and HDL cholesterol levels were noted down. Sixty patients (51 women) were included in the study. There was significant difference in terms of BMI (P = 0.034), age (P = 0.001), waist circumference (P = 0.048) and disease duration (P = 0.005) between chronic low back pain patients with and without metabolic syndrome. There was no significant difference in other parameters. Low back pain is a frequent complaint amongst people with obesity in the abdominal area. According to our results, elderly people, people with chronic low back pain and patients with high BMI are under risk for metabolic syndrome. For this reason this group of patients can be screened for metabolic syndrome and preventive measures can be taken.
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Dor Lombar/epidemiologia , Síndrome Metabólica/epidemiologia , Atividades Cotidianas , Adulto , Índice de Massa Corporal , Doença Crônica , Comorbidade , Avaliação da Deficiência , Feminino , Humanos , Dor Lombar/diagnóstico , Dor Lombar/fisiopatologia , Masculino , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/fisiopatologia , Medição da Dor , Inquéritos e Questionários , Turquia/epidemiologiaRESUMO
A web-based application patient follow-up program was developed to create a registry of patients with ankylosing spondylitis (AS) by the Turkiye Romatizma Arastirma Savas Dernegi (TRASD) AS Study Group. This study describes the methodological background and patient characteristics. The patient follow-up program is a web-based questionnaire, which contains sections on socio-demographic data, anamnesis, personal and family history, systemic and musculoskeletal examination, laboratory and imaging data and treatment. Between October 1, 2007 and February 28, 2009, 1,381 patients from 41 centers were included in the registry (1,038 males [75.2%]; mean age 39.5 ± 10.7 years). Mean disease duration was 12.1 ± 8.5 years, and mean time from initial symptom to diagnosis was 5 ± 6.8 years (median 2 years). HLA-B27 positivity was detected in 73.7% of 262 patients tested. Manifestations of extraarticular involvement were anterior uveitis (13.2%), psoriasis and other skin and mucous membrane lesions (6%) and inflammatory bowel disease (3.8%). The prevalence of peripheral arthritis was 11.2%. In 51.7% of patients, the Bath AS Disease Activity Index was ≥4. But since our patients consisted of the ones with more severe disease who referred to the tertiary centers and needed a regular follow-up, they may not represent the general AS population. Disease-modifying anti-rheumatic drugs were being used by 41.9% of patients, with 16.4% using anti-TNF agents. TRASD-IP (Izlem Programi: Follow-up program) is the first AS registry in Turkey. Such databases are very useful and provide a basis for data collection from large numbers of subjects. TRASD-IP gives information on the clinical and demographic profiles of patients, and the efficacy and safety of anti-TNF drugs, examines the impact on quality of life, and provides real-life data that may be used in cost-effectiveness analyses.
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Antirreumáticos/uso terapêutico , Internet , Sistema de Registros , Índice de Gravidade de Doença , Espondilite Anquilosante/tratamento farmacológico , Espondilite Anquilosante/fisiopatologia , Inquéritos e Questionários , Adulto , Antirreumáticos/efeitos adversos , Artrite/epidemiologia , Comorbidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Qualidade de Vida , Estudos Retrospectivos , Espondilite Anquilosante/epidemiologia , Resultado do Tratamento , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Turquia/epidemiologiaRESUMO
Ankylosing spondylitis (AS) is a chronic inflammatory disorder of the axial skeleton. In recent years, several authors reported an increased prevalence of sexual dysfunction among AS patients. We aimed to find out, whether the prevalence of erectile dysfunction among AS patients is different from age-matched healthy controls. Thirty-seven male patients with AS who were diagnosed according to the modified New York criteria and 67 normal healthy controls (NHC) were included in this study. Clinical characteristics of patients including age, disease duration and morning stiffness were noted. Disease activity was evaluated by using Bath AS disease activity index (BASDAI), functional statement was evaluated by using Bath AS functional index, and scores of spinal measurements were done by using Bath AS metrology index. Erectile function is evaluated using the International Index of Erectile Function (IIEF) scoring system. Health-related quality of life was assessed by short form 36. The mean age of the patients and controls were 42.8 + 10.8 and 43.6 + 5.9 years (P = 0.666). The prevalence of erectile dysfunction in AS patients and NHC were 35.1 and 26.9%, respectively (P = 0.335). There was no statistically significant difference between IIEF domain scores of AS patients and NHC except for the sexual desire domain (P = 0.014). Duration of morning stiffness and BASDAI was negatively correlated with sexual desire and overall satisfaction; however, they have no negative impact on erectile function, orgasmic function and intercourse satisfaction domains of IIEF. In this report, we showed that only the sexual desire domain of IIEF was significantly lower in AS patients. The prevalence of erectile dysfunction among AS patients is similar to NHC, which is a finding contrary to previous reports. AS patients do not suffer from erectile dysfunction, they rather have problems of satisfaction from the intercourse.
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Disfunção Erétil/epidemiologia , Sexualidade , Espondilite Anquilosante/epidemiologia , Adulto , Coito/psicologia , Disfunção Erétil/fisiopatologia , Disfunção Erétil/psicologia , Nível de Saúde , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Espondilite Anquilosante/fisiopatologia , Espondilite Anquilosante/psicologiaRESUMO
AIM: The aim of this study was to investigate whether women giving preterm birth have joint hypermobility. METHODS: The study included 44 women giving preterm birth (study group) and 48 women with the history of term birth (control group). After demographic data were recorded, the presence of joint hypermobility based on the Beighton diagnostic criteria and subgroup scores were noted down. Total Beighton scores were compared between the study and control groups. RESULTS: The total Beighton scores were significantly higher in the study group (p < .001). The study group had the highest hypermobility score for elbow hyperextension and the lowest hypermobility score for thumb hyperextension. CONCLUSIONS: It should be kept in mind that joint hypermobility detected during follow-up of pregnancy can be related to the risk of preterm birth. Informing pregnant women with joint hypermobility about the possibility of preterm birth could be helpful.
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Instabilidade Articular , Nascimento Prematuro , Feminino , Humanos , Recém-Nascido , Instabilidade Articular/complicações , Instabilidade Articular/epidemiologia , Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , PolegarRESUMO
OBJECTIVES: Demonstrate of accidental intravascular injection during lumbar transforaminal anterior epidural steroid injection (TAESI) performed with three-dimensional imaging angiography (3DIA) and fluoroscopy. METHODS: We assessed 20 (9 males and 11 females) patients (with a total of 40 levels) whose images were received with simultaneously 3DIA and fluoroscopy-guided TAESI between January 2016 and September 2016 as retrospective. Injections were carried out in the lumbar fourth intervertebral space bilaterally and performed in the same way all of the cases. RESULTS: The mean age and body mass index of the patients were 47.9±2.72 years and 26.95±1.21, respectively. There were 10 patients with disc herniation, seven patients with spinal stenosis, and three patients with failed back surgery syndrome. In 3D imaging, vascular escape was detected in the 7 levels (17.5%) which were thought to be no escape in the fluoroscopy imaging. CONCLUSION: In chronic lumbar radiculopathy patients, intravascular escapes may occur during the fluoroscopic TAESI procedure. To avoid intravascular injections during TAESI procedure, it may be appropriate to use different imaging methods that can give more detailed results such as 3D angiography.
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Radiculopatia , Feminino , Fluoroscopia , Humanos , Injeções Epidurais , Vértebras Lombares/diagnóstico por imagem , Masculino , Radiculopatia/tratamento farmacológico , Estudos Retrospectivos , Esteroides/uso terapêuticoRESUMO
Background: Development of methods to accelerate nerve regeneration in peripheral nerve damage is important. Electroacupuncture is a new therapeutic method that combines traditional acupuncture with modern electrotherapy. Melatonin has been shown to reduce nerve damage. Objectives: In this study, we aimed to determine and compare the therapeutic effects of electroacupuncture and melatonin on rat sciatic nerve injury. Methods: A total of 56 adult male Wistar Albino rats were divided into four study groups with 14 animals in each group: intact control (group I), subcutaneous saline (group II), subcutaneous melatonin (group III), and electroacupuncture (group IV). Surgical procedure including unilateral (right) sciatic nerve injury was applied to groups II, III, and IV. Saline and melatonin started immediately after surgery for six weeks, while electroacupuncture was given two weeks after surgery for 3 weeks. Functional and histological assessments were used as outcome measurements. Results: Sciatic nerve damage caused a significant decrease in nerve conduction velocity. Both electroacupuncture treatment and melatonin treatment significantly increased the nerve conduction velocity. Both sciatic functional recovery and histological regeneration were faster in these treatment groups compared to the saline. However, no significant difference was observed between the two treatment groups. Conclusion: Electroacupuncture and melatonin are promising alternative treatment strategies for peripheral nerve damage and can be examined in detail in future studies.
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Eletroacupuntura , Melatonina , Animais , Masculino , Melatonina/farmacologia , Melatonina/uso terapêutico , Regeneração Nervosa , Ratos , Ratos Wistar , Nervo IsquiáticoRESUMO
Ollier disease is a rare, non-hereditary mesodermal dysphasia, characterized by multiple enchondromas, which demonstrate asymmetric involvement of the metaphyses of the long bones. Many malignancies, especially chondrosarcomas, may be observed in association with this disease. The clinical and radiologic characteristics of a case involving a 44-year-old male patient with non-small cell lung cancer are presented together with the clinical characteristics of other cases reported in the literature.
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Neoplasias Ósseas/secundário , Carcinoma Pulmonar de Células não Pequenas/secundário , Encondromatose/diagnóstico , Neoplasias Pulmonares/patologia , Adolescente , Adulto , Amputação Cirúrgica , Anti-Inflamatórios não Esteroides/uso terapêutico , Artralgia/etiologia , Biópsia , Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/etiologia , Osso e Ossos/diagnóstico por imagem , Osso e Ossos/patologia , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/etiologia , Carcinoma Pulmonar de Células não Pequenas/terapia , Criança , Encondromatose/complicações , Encondromatose/terapia , Fadiga/etiologia , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/etiologia , Neoplasias Pulmonares/terapia , Masculino , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
Chronic exposure to n-hexane is one of the well known causes of peripheral neuropathy. This type of neuropathy is commonly seen among individuals employed in shoe and bag factories with inadequate ventilation. We describe three patients with acute and sub-acute neuropathy following n-hexane exposure via inhalation of glue. All of the patients had history of working in the same place. The results of laboratory examinations were in normal ranges except the electroneuromyographic (ENMG) findings which were showing the neuropathy. All patients were hospitalized and rehabilitation programs were carried out. Symptomatic relief was achieved following this treatment, however the pathologic ENMG findings still persisted.
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Adesivos/toxicidade , Hexanos/toxicidade , Polineuropatias/induzido quimicamente , Solventes/toxicidade , Doença Aguda , Adesivos/química , Adolescente , Eletromiografia , Hexanos/química , Hospitalização , Humanos , Exposição por Inalação , Masculino , Exposição Ocupacional , Polineuropatias/diagnóstico , Polineuropatias/reabilitação , Solventes/química , Resultado do Tratamento , Adulto JovemRESUMO
We proposed to assess antioxidant status and nitric oxide in fibromyalgia (FM) patients in comparison to healthy controls. Additionally, the association between the serum antioxidant levels and clinical findings in FM patients was also investigated. Thirty-seven FM patients and 37 healthy controls were enrolled in this study. Severity of fatigue and pain were determined by Visual Analogue Scale. Functional capacity in daily living activities was evaluated by fibromyalgia impact questionnaire. Serum NO, catalase and glutathione were measured. Serum glutathione and catalase levels were significantly lower in FM patients than controls. However, no significant difference was seen in serum NO levels between the two groups. A significant correlation was evident between serum NO level and pain. Additionally, the correlation between glutathione level and morning stiffness was found to be significant. These findings support other studies, we assume that these two antioxidants might have impact on the pathogenesis of FM disease.
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Antioxidantes/análise , Fibromialgia/sangue , Óxido Nítrico/sangue , Atividades Cotidianas , Adulto , Estudos de Casos e Controles , Catalase/sangue , Eritrócitos/enzimologia , Fadiga/etiologia , Feminino , Fibromialgia/fisiopatologia , Glutationa/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Nitritos/sangue , Índice de Gravidade de Doença , Transtornos do Sono-Vigília/etiologia , Inquéritos e QuestionáriosRESUMO
Spondyloepiphyseal dysplasia tarda with progressive arthropathy (SEDT-PA) is an autosomal recessively inherited skeletal dysplasia. We present four patients (three patients-a brother and a sister and their third cousin-in a family and one patient in another family) with SEDT-PA. All patients had short stature and stubby hands and feet. Their radiographs revealed typical changes for SEDT-PA including platyspondyly, severe osteopenia and dysplastic bone changes. Physical therapy and exercises were performed to all patients in order to decrease in pain and increase or at least maintain joint motion and mobility. Symptomatic relief was achieved in all patients for about a couple of months. The major clinical importance of this rather rare disorder is its similarity to juvenile idiopathic arthritis which has rather different treatment protocol.
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Artrite Juvenil/diagnóstico , Artropatia Neurogênica/genética , Família , Osteocondrodisplasias/diagnóstico , Osteocondrodisplasias/genética , Adulto , Criança , Diagnóstico Diferencial , Feminino , Genes Recessivos , Mãos/diagnóstico por imagem , Mãos/fisiopatologia , Humanos , Masculino , Osteocondrodisplasias/diagnóstico por imagem , Medição da Dor , Radiografia , Amplitude de Movimento Articular , Irmãos , Adulto JovemRESUMO
Our aim in this study was to investigate serum hyaluronic acid (HA) levels and the relationship between clinical parameters in ankylosing spondylitis (AS). Approximately 30 patients with AS and 30 healthy individuals were recruited in this study consecutively. Cross-sectional study was planned, and demographic, clinical, functional, radiological, and laboratory data of patients were evaluated. Disease activity, functional status, and quality of life were assessed, respectively, with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Short-Form 36 (SF-36). Mander Enthesis Index (MEI) was used for evaluation of enthesis involvement. We examined serum concentrations of HA (ng/ml) in patients with AS and controls. The mean ages of patients and control group were 38.3 (SD=10.8) and 42.7 (SD=10.6) years, respectively. The mean of serum HA levels in AS patients was 40.4 (SD=34.8) ng/ml and in controls was 24.9 (SD=20.2). There was significant difference of HA levels between two groups (p=0.04). Furthermore, there was a significant correlation between HA level and distance of hand-floor (r=0.444, p=0.014), modified lumbar Schober's (r= -0.413, p=0.023), distance of chin to chest (r=0.436, p=0.016), right sacroiliit grade (r=0.601, p<0.001), left sacroiliit grade (r=0.610, p<0.001), C reactive protein level (r=0.404, p=0.027), albumin (r= -0.464, p=0.010), C3 (p=0.449, p=0.013), and IgA levels (r=0.369, p=0.045). However, there was no significant correlation between HA levels with MEI, BASFI, BASDAI, and SF-36 (p >or= 0.05). Serum HA level was significantly higher in AS patients than controls. However, there was no significant correlation between serum HA level and disease-specific measures as BASFI and BASDAI; it had significant relation with spinal mobility limitation, sacroiliitis, and laboratory parameters related with acute inflammation. The serum HA level may be a potential biomarker of axial inflammation and disease severity in AS.
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Ácido Hialurônico/sangue , Espondilite Anquilosante/sangue , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Articulação Sacroilíaca/diagnóstico por imagem , Articulação Sacroilíaca/fisiopatologia , Coluna Vertebral/fisiopatologia , Espondilite Anquilosante/diagnóstico por imagem , Espondilite Anquilosante/fisiopatologiaRESUMO
OBJECTIVES: To compare the efficacy of intra-articular injection and radiofrequency (RF) neurotomy of genicular nerves in patients with chronic knee osteoarthritis (OA) pain. METHODS: Seventy-three patients with knee OA were included in the study. Patients were randomly assigned to Group IA (intra-articular 2.5 mL of bupivacaine, 2.5 mg of morphine and 1 mL of betamethasone, 6 mL of fluid injection) or Group RF (RF neurotomy of the genicular nerves). The outcome measures included a pain scale (visual analog scale, VAS) and Western Ontario and McMaster Universities (WOMAC) Index of Osteoarthritis. RESULTS: No statistically significant difference was found between the two groups in baseline VAS-pain. In Group RF, a significant reduction was observed in VAS-pain at the first month (P < 0.001) and the third month (P < 0.001) in comparison to Group IA. Also in Group RF, a significant reduction was observed in WOMAC total scores in the first month (P < 0.001) in comparison to Group IA. CONCLUSION: This study is the first controlled study in the literature which compares RF genicular nerve to intra-articular injections. This study demonstrated that genicular nerve RF neurotomy is a safe and efficient treatment modality and provides functional improvement along with an analgesia in patients with chronic knee OA.
Assuntos
Analgésicos/administração & dosagem , Artralgia/terapia , Dor Crônica/terapia , Denervação/métodos , Articulação do Joelho/inervação , Osteoartrite do Joelho/terapia , Idoso , Idoso de 80 Anos ou mais , Analgésicos/efeitos adversos , Analgésicos Opioides/administração & dosagem , Anestésicos Locais/administração & dosagem , Artralgia/diagnóstico , Artralgia/etiologia , Betametasona/administração & dosagem , Bupivacaína/administração & dosagem , Dor Crônica/diagnóstico , Dor Crônica/etiologia , Denervação/efeitos adversos , Feminino , Glucocorticoides/administração & dosagem , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Morfina/administração & dosagem , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/diagnóstico , Medição da Dor , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , TurquiaRESUMO
We examined the association between clinical parameters of disease activity and serum hyaluronic acid (HA) level in patients with knee osteoarthritis (OA). Fifty-eight patients with knee OA and 40 healthy individuals were included in this study. Demographic data were noted. The radiological evaluation was done according to Kellgren/Lawrence Grading System. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used in evaluating the clinical disability caused by OA. Erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) level were determined in laboratory evaluations. Serum HA levels (in nanogram per milliliter) of both groups were measured by enzyme-linked immunosorbent assay. The mean ages of patients in OA group and control group were 57.58 (9.55) and 43.3(10.2) years, respectively. There was a significant difference between HA levels of both groups (p=0.02). Also, there was a significant correlation between HA level and disease duration (p=0.04), ESR (p=0.001), and CRP level (p<0.001). However, there was no significant correlation between HA levels with WOMAC and radiological grade (p>0.05). There is no satisfactory amount of data regarding HA level in OA. In our study, we demonstrated that HA was in high levels in the serum of patients with OA. We suggest that serum HA levels may be used as a marker to determine the disease activity.
Assuntos
Ácido Hialurônico/sangue , Osteoartrite do Joelho/sangue , Idoso , Proteína C-Reativa/análise , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Generalized joint laxity is often associated with gait deviations. The aim of this study was to investigate the static and dynamic loading pattern of the foot with increasing joint mobility and to discuss the potential impact of this condition on the plantar loading patterns. METHODS: Seventy female participants between ages of 18 and 30 were included in this cross-sectional survey. The Beighton-Horan Joint Mobility Index scores were assessed and participants divided into 3 categories: no hypermobility (NH) group, scores 0 to 2; moderate hypermobility (MH) group, scores 3 to 4; distinct hypermobility (DH) group, scores 5 to 9. Pedobarographic analysis was performed both in static and walking conditions. Dynamic foot loading examined in 10 anatomic zones. Contact areas of forefoot, midfoot, and rearfoot were recorded. RESULTS: In the dynamic pedobarographic analysis, individuals with distinct joint hypermobility displayed higher peak pressure and maximum force values under the hallux, compared with other groups ( P < .05). The maximum force value of the second metatarsal was higher in the DH group than in the MH group ( P < .05). CONCLUSION: Our study results suggest that plantar loading pattern differs with increasing degrees of the hypermobility score. CLINICAL RELEVANCE: Differences in plantar loading parameters in people with severe joint mobility scores may be useful in interpreting the foot pathologies of these individuals.