Study design: A prospective study. Objectives: To investigate the risk factors predicting upper u... more Study design: A prospective study. Objectives: To investigate the risk factors predicting upper urinary tract (UUT) deterioration in patients with spinal cord injury (SCI). Setting: Beijing, China. Methods: We reviewed the medical records and UUT imaging studies of 112 patients, with a mean follow-up of 2 years. Variables evaluated for possible influence on UUTs included patient age, gender and educational background; injury level and completeness; bladder management method; and the presence of adverse outcomes such as recurrent urinary tract infections and bladder stones. Video urodynamic data were also reviewed. Total renal function was assessed by serum creatinine. UUT abnormalities were assessed by renal ultrasound or magnetic resonance imaging. Results: Lumbosacral spinal cord lesions likely contribute to UUT deterioration. UUT abnormalities were present in 23 patients (65.7%) in a spontaneous voiding group, 10 patients (20%) in a clean intermittent catheterization group, 15 patients (78.9%) in an indwelling urethral catheterization group and 7 patients (87.5%) in a suprapubic Foley catheterization group (Po0.001). When dividing bladder management method into two groups, catheter-free (spontaneous and intermittent voiding) and indwelling catheter (urethral and suprapubic catheterization), there was UUT dysfunction in 33 patients (38.3%) and 22 patients (81.5%), respectively (Po0.001). Conclusions: Lumbosacral SCI and chronic indwelling urethral and suprapubic catheterization were predictors of UUT deterioration.
Prolonged human life span and amelioration of the current health conditions brings up the risk of... more Prolonged human life span and amelioration of the current health conditions brings up the risk of fracture related to osteoporosis as an important medical problem. In this study, we aim to study the effect of fracture on quality of life with 29 postmenopopausal women with fracture and 33 without osteoporotic fracture. Demographic data, height, maximum height, body weight, body weight at age 25, localization of fracture of the patients were recorded. All of the patients' bone mineral densities (BMD) were evaluated with Dual energy X ray absorbtiometri (DXA). For evaluating quality of life Short Form 36 (SF 36) survey was used. In this study there were no statistical differences between the 2 groups when their age, menarc age, menopause age, number of pregnancies, height, body weight, maximum height and body weight at age 25 were compared. There was statistical difference between the groups in their shortening of height. When BMD levels were compared with DXA it was noted that the...
Turkish Journal of Physical Medicine and Rehabilitation, 2021
Objectives: This study aims to investigate the prevalence, etiology, and risk factors of cervicog... more Objectives: This study aims to investigate the prevalence, etiology, and risk factors of cervicogenic dizziness in patients with neck pain. Patients and methods: Between June 2016 and April 2018, a total of 2,361 patients (526 males, 1,835 females; mean age: 45.0±13.3 years; range, 18 to 75 years) who presented with the complaint of neck pain lasting for at least one month were included in this prospective, cross-sectional study. Data including concomitant dizziness, severity, and quality of life (QoL) impact of vertigo (via Numeric Dizziness Scale [NDS]), QoL (via Dizziness Handicap Inventory [DHI]), mobility (via Timed Up-and-Go [TUG] test), balance performance [via Berg Balance Scale [BBS]), and emotional status (via Hospital Anxiety- Depression Scale [HADS]) were recorded. Results: Dizziness was evident in 40.1% of the patients. Myofascial pain syndrome (MPS) was the most common etiology for neck pain (58.5%) and accompanied with cervicogenic dizziness in 59.7% of the patients. ...
Osteoporosis is a silent, asymptomatic disease until a fragility fracture is sustained. Fractures... more Osteoporosis is a silent, asymptomatic disease until a fragility fracture is sustained. Fractures greatly affect the physical functioning and health-related quality of life and are associated with increased mortality and morbidity rates. Furthermore, once a fragility fracture occurs, the patient is more susceptible to sustain further fractures. Repeated falls are the main causes of fractures in patients with osteoporosis. The management of osteoporosis postfracture is a combination of medical treatment, nutritional interventions, and rehabilitation in order to improve activities of daily living to prevent falls and increase safety while reducing the loss of bone mass. In this article the principles of fracture prevention and physical rehabilitation of patients with osteoporosis postvertebral and hip fragility fractures will be discussed, as well as the rehabilitation management to prevent further falls and fractures.
During the acute and chronic phase of spinal cord injury (SCI) bone turnover and structure are af... more During the acute and chronic phase of spinal cord injury (SCI) bone turnover and structure are affected. Bone mineral density of lower limbs is decreased up to 28%-50% below that of age-matched peers at 12-18 mo post injury. Coexisting secondary etiologies of osteoporosis may be present, and during ageing additional loss of bone occurs. All these compose a complex canvas of bone impairment after spinal cord injury and make the therapeutical approach challenging. The risk of fragility fractures is increased after the 2nd decade post SCI affecting the functionality and quality of life of individuals with SCI. Diagnostic flaws, lack of a ranking system to categorize the degree of bone impairment similar to the one of World Health Organization, and evidence-based clinical guidelines for management in SCI requires interdisciplinary cooperation and appropriate planning of future research and interventions. Spinal Cord Section of Hellenic Society of Physical Rehabilitation Medicine convened an expert panel working group on bone and spinal cord injury at the Pan-Hellenic Congress 2018 of PRM in Athens Greece, to establish an evidence-based position statement for bone loss in individuals with SCI of traumatic or non-traumatic etiology. This was reviewed by an International Task Force and used to create S1 Guidelines. This first version S1 guideline will work towards to provide help with prophylactic basic osteoporosis therapy diagnostic and therapeutic decisions in acute and chronic phase and rehabilitation countermeasures against osteoporosis related with spinal cord injury.
The effects of caregiver burden during the inpatient rehabilitation period have not yet been inve... more The effects of caregiver burden during the inpatient rehabilitation period have not yet been investigated. The purpose of this study was to evaluate the burden on stroke survivors' caregivers during the inpatient rehabilitation period, and to compare the associations of robot-assisted gait training and conventional therapy with caregiver burden. Our randomized, crossover, prospective study included 63 stroke survivors and their caregivers, who were randomly assigned to one of two groups. The patients in group I received robot-assisted gait training for 2 weeks, followed by conventional therapy for a further 2 weeks. The patients in group II received conventional therapy for 2 weeks followed by robot-assisted gait training for a further 2 weeks. The caregiver burden inventory, beck depression index, and beck hopelessness scale were administered to the caregivers at day 0, on the “switch day” (day 15), and day 30. Before inpatient rehabilitation, 18 (35%) of the caregivers had somewhat elevated scores on the caregiver burden inventory; however, at the end of rehabilitation, 42 (66.6%) of the caregivers were in a high-burden state. The caregiver burden inventory scores differed significantly between baseline and the end of rehabilitation in both groups. Caregiver depression scores also increased significantly in both groups (p < 0.0001), while hopelessness scores increased only in group II (p = 0.027). Caregiver burden increased during the inpatient stroke rehabilitation period. During inpatient rehabilitation, both robot-assisted gait training and conventional therapy increased caregiver burden. ClinicalTrials.gov Number NCT03535467, First Posted: 24 May 2018.
Gebelikte bel ağrısı, gebeliğe bağlı gelişen postural ve hormonal değişiklikler sonrası ortaya çı... more Gebelikte bel ağrısı, gebeliğe bağlı gelişen postural ve hormonal değişiklikler sonrası ortaya çıkan ve gebelikte en sık görülen kas iskelet sistemi semptomudur. Gebelikte bel ağrısına neden olan durumlar; pelvik relaksasyon, lomber diskopati, spondilolistezis, koksidini ve postüral bel ağrısı olarak sıralanabilir (1). Sıklıkla ikinci ve üçüncü trimesterde ağrı belirginleşir. Bel ağrısı ile başvuran gebede önemli olan ağrının lokalizasyonu ve yayılımıdır. Siyatalji, spinal sinir kökü basısına işaret eder ve siyatik sinir trasesine uyan ağrı ile başvuran gebede ilk akla gelmesi gereken patoloji lomber disk herniasyonu (LDH) olmalıdır (2). Semptomatik LDH 1-25/10,000 gibi daha nadir olarak karşımıza çıkmaktadır. Gebeliğin LDH için bağımsız bir risk faktörü olduğu ve var olan disk herniasyonunu kötüleştirebildiği bildirilmektedir (1). Kalçanın geçici osteoporozu (KGO) ise kalça ağrısının spontan başlayıp, zamanla ortadan kalktığı ve femur başında geç beliren osteoporoz görünümü ile karakterize nadir görülen bir klinik tablodur (3). İlk 1959'da üçüncü trimesterde olan üç gebede "kalçanın geçici demineralizasyonu" olarak Curtiss ve Kincaid tarafından tanımlanmıştır. 1967'de Duncan yük taşıyan eklemlerde ardı sıra gelişen poliartiküler artralji için "gezici bölgesel osteoporoz" tanımını kullanmış, 1968'de Lequesne tarafından "KGO" şeklinde isimlendirme yapılmıştır. İdiyopatik bölgesel osteoporoz, geçici ağrılı osteoporoz, geçici osteopeni, algodistrofi gibi tanımlamalar kullanılsa da günümüzde en yaygın kullanılan KGO ve geçici kemik iliği ödemi sendromudur (4). Sıklıkla 40-60 yaşlarındaki orta yaşlı erkeklerde ve gebeliğin üçüncü trimesterindeki kadınlarda görülmektedir. Bilateral
Background Unsuitable samples are common problem for laboratories. The blood collection tubes nee... more Background Unsuitable samples are common problem for laboratories. The blood collection tubes need to be validated or verified prior to their being used in the routine laboratory for reducing this situation. Objective We aim to compare the technical qualifications of routinely used BD Vacutainer® Serum Separator Tubes™ II Advance Plus with BD Vacutainer® Barricor™ LH Plasma Tubes for local technical validation. Materials and methods Apparently healthy 150 voluntary subjects were enrolled in the study. Samples were collected in two separated tubes by a single phlebotomist. Twelve quality indicators were used to compare these two different types of tubes for local technical validation. Differences (%) between them were calculated with the formula proposed by EFLM. In case of any difference of less than 1% for each indicator, the evaluated tube was considered as non-inferior. Results Indicators, such as tubes with physical defects, that fail to create vacuum, not properly fitting into ...
Karahan ve ark. D Vitamin ve Kas İskelet Sistemi Ağrıları Öz Objective: In this study, it was aim... more Karahan ve ark. D Vitamin ve Kas İskelet Sistemi Ağrıları Öz Objective: In this study, it was aimed to evaluate the relationship between vitamin D level and pain severity, localization and duration in patients with non-specific musculoskeletal pain. Materials and Methods: Patients who applied to physical medicine and rehabilitation outpatient clinics due to non-specific muscle pain in 19 centers in Turkey were retrospectively screened. Three thousand four hundred fourpatients were included in the study, whose pain level was determined by visual analog scale (VAS) and the painful region, duration of pain and vitamin D level were reached. D group was found to be D deficient (group 1) when 25 (OH)D level was 20 ng/mL or less and group D 2 (vitamin D deficiency) was higher than 30 ng/mL (group 3). The groups were compared in terms of pain duration, localization and severity. In addition, the correlations of pain localization, severity and duration with vitamin D levels were examined. Results: D vitamin deficiency was detected in 2202 (70.9%) of 3 thousand four hundred and four registered patients, and it was found that vitamin D deficiency in 516 (16.6%) and normal vitamin D in 386 (12.4%). The groups were similar in terms of age, body mass index, income level, duration of complaint, education level, family type and working status (p>0.05). There was no statistically significant difference between groups in terms of VAS, pain localization and duration scores (p>0.05). Conclusion: Our study shows that vitamin D deficiency in patients with nonspecific musculoskeletal pain is not associated with the severity and duration of pain.
Study design This was a single-centre, retrospective, descriptive, hospital-based study in person... more Study design This was a single-centre, retrospective, descriptive, hospital-based study in persons with spinal cord injuries (SCI) patients. Objectives To study the incidence and characteristics of heterotopic ossification (HO) after SCI. Setting The in-patient services of the Department of Physical Medicine and Rehabilitation of a tertiary care institute in India between January 2001 and December 2017. Methods Medical records of all consecutive patients with diagnosis of SCI in the age group of 15-60 years were reviewed for presence of HO (diagnosed by clinical signs, laboratory investigations (ALP, ESR and X-rays)) and characteristics of HO. R-Ver 3.4.2 was used for analysis and correlations. Results were considered significant at P < 0.05. Results A total of 303 patients satisfied inclusion criteria. Nineteen individuals (6.3%) had developed HO. Seven (37%) were diagnosed within 3 months of SCI. Twelve (63%) patients developed unilateral HO. The most common site for HO was hip joint (73%). A significant association was found between the presence of a pressure ulcer and development of HO (P = 0.01). Conclusions The incidence of HO was 6.3% in our institution and the hip joint is the most common site. Due to the presence of limited treatment options it is important to diagnose HO early in patients with SCI based on clinical features and later confirmed with laboratory tests and imaging.
The purpose of this study was to compare the effects of different injection technique guidance wi... more The purpose of this study was to compare the effects of different injection technique guidance with electrical stimulation (ES) vs ultrasonography (USG) of botulinum toxin A injection (BoNT A) in post-stroke patients with plantar flexor spasticity. Forty chronic post-stroke patients with plantar flexor spasticity and who were able to walk were included in the study. They were randomized into two groups: in 20 patients the BoNT A injection was applied with the guidance of ES and in 20 patients with the guidance of USG by the same physician. Gastrocnemius, soleus, and tibialis posterior were injected. Spasticity was evaluated by ashworth scale; the functional status was evaluated by ankle goniometry for range of motion, Brunnstrom stages, Barthel Index, and 10-m walk test before the treatment, 2nd week, and 3rd month after the treatment. Statistical significance was defined as p < 0.05. Two groups were similar in respect to demographical and clinical features. In both groups, walking speed and range of motion increased significantly after the treatment. When the two groups were compared at 3rd month after the treatment; range of motion of the ankle joint plantar flexion and dorsiflexion when knee in extension showed a significant difference between the two groups. Ashworth scale, Brunnstrom stages, Barthel index, walking speed tests, and other ankle goniometry for range of motion showed no statistically significant difference between two groups. We can conclude that USG and ES guidence are both effective injection techniques when applying BoNT A to ankle plantar flexor muscles.
Background: Review of the literature clearly reveals that little is known about the association b... more Background: Review of the literature clearly reveals that little is known about the association between functional and mental status, and Lower Urinary Tract Dysfunction (LUTD) in patients with stroke. Objective: The aim of this study was to assess functional and mental status in stroke patients and to identify possible associations with the prevalence, severity and bother of LUTD. Material and methods: This study was designed as a cross-sectional study and included 260 stroke patients enrolled from six different hospitals in Turkey. The patients were questioned using the Danish Prostatic Symptom Score (DAN-PSS) Questionnaire to evaluate LUTD, and evaluated using the Modified Barthel Index (MBI), Incontinence Quality of Life Questionnaire (I-QoL), and the Mini Mental State Examination (MMSE). Results: At least one LUTD finding was reported in 243 (93.5%) patients; the most commonly encountered complaint in these patients was nocturia (75.8%). The mean MBI, MMSE, and I-QoL scores were found to be significantly lower in LUTD (+) patients compared to LUTD (−) patients (p = 0.000, p = 0.005, and p < 0.01, respectively). Similarly all parameters (MBI, MMSE, and I-QoL scores) assessed were found to be significantly lower for patients with urinary incontinence than those without incontinence (p = 0.000, p = 0.000, and p < 0.01, respectively). Conclusion: LUTD is a common problem in patients with stroke. LUTD is associated with poorer cognitive and functional status and the quality of life in these patients. We, therefore, suggest that bladder dysfunction should not be overlooked during rehabilitation of stroke patients.
Objective: To assess the impact of spasticity severity as well as socio-demographic and clinical ... more Objective: To assess the impact of spasticity severity as well as socio-demographic and clinical factors on quality of life (QOL) and to identify factors predicting poor QOL among patients with spinal cord injury (SCI) Design: Descriptive cross-sectional study. Setting: Tertiary care clinic in Istanbul, Turkey. Participants: A total of 110 patients with SCI (mean (SD) age: 43.8 (14.7) years, 58.2% were males) were enrolled. Assessments: The American Spinal Injury Association (ASIA) Impairment Scale (AIS), Modified Ashworth Scale (MAS) and Turkish version of the World Health Organization Quality of life questionnaire (WHOQOL-BREF) were utilized to determine the SCI category, severity of spasticity and QOL scores, respectively. Outcome measures: The WHOQOL-BREF scores were evaluated with respect to the severity of spasticity, aetiology and duration of SCI, AIS category and method of bladder management. Results: The mean (SD) physical health (41.9 (15.3) vs. 46.5 (10.9), P = 0.029), social relationships (45.6 (20.2) vs. 53.8 (17.3), P = 0.025) and total WHOQOL-BREF scores were significantly lower in patients with more severe spasticity. Multivariate linear regression analysis revealed that severity of spasticity was a significant predictor of decreased WHOQOL-BREF total scores, physical domain scores and social relations domain scores by 11.381 (P = 0.007), 11.518 (P = 0.005) and 17. 965 (P = 0.004), respectively. Conclusion: In conclusion, addressing QOL in relation to severity of spasticity for the first time among Turkish SCI patients, our findings revealed a negative impact of the spasticity severity on the WHOQOL-BREF scores, particularly for physical health and social relationship domains.
Study design: A prospective study. Objectives: To investigate the risk factors predicting upper u... more Study design: A prospective study. Objectives: To investigate the risk factors predicting upper urinary tract (UUT) deterioration in patients with spinal cord injury (SCI). Setting: Beijing, China. Methods: We reviewed the medical records and UUT imaging studies of 112 patients, with a mean follow-up of 2 years. Variables evaluated for possible influence on UUTs included patient age, gender and educational background; injury level and completeness; bladder management method; and the presence of adverse outcomes such as recurrent urinary tract infections and bladder stones. Video urodynamic data were also reviewed. Total renal function was assessed by serum creatinine. UUT abnormalities were assessed by renal ultrasound or magnetic resonance imaging. Results: Lumbosacral spinal cord lesions likely contribute to UUT deterioration. UUT abnormalities were present in 23 patients (65.7%) in a spontaneous voiding group, 10 patients (20%) in a clean intermittent catheterization group, 15 patients (78.9%) in an indwelling urethral catheterization group and 7 patients (87.5%) in a suprapubic Foley catheterization group (Po0.001). When dividing bladder management method into two groups, catheter-free (spontaneous and intermittent voiding) and indwelling catheter (urethral and suprapubic catheterization), there was UUT dysfunction in 33 patients (38.3%) and 22 patients (81.5%), respectively (Po0.001). Conclusions: Lumbosacral SCI and chronic indwelling urethral and suprapubic catheterization were predictors of UUT deterioration.
Prolonged human life span and amelioration of the current health conditions brings up the risk of... more Prolonged human life span and amelioration of the current health conditions brings up the risk of fracture related to osteoporosis as an important medical problem. In this study, we aim to study the effect of fracture on quality of life with 29 postmenopopausal women with fracture and 33 without osteoporotic fracture. Demographic data, height, maximum height, body weight, body weight at age 25, localization of fracture of the patients were recorded. All of the patients' bone mineral densities (BMD) were evaluated with Dual energy X ray absorbtiometri (DXA). For evaluating quality of life Short Form 36 (SF 36) survey was used. In this study there were no statistical differences between the 2 groups when their age, menarc age, menopause age, number of pregnancies, height, body weight, maximum height and body weight at age 25 were compared. There was statistical difference between the groups in their shortening of height. When BMD levels were compared with DXA it was noted that the...
Turkish Journal of Physical Medicine and Rehabilitation, 2021
Objectives: This study aims to investigate the prevalence, etiology, and risk factors of cervicog... more Objectives: This study aims to investigate the prevalence, etiology, and risk factors of cervicogenic dizziness in patients with neck pain. Patients and methods: Between June 2016 and April 2018, a total of 2,361 patients (526 males, 1,835 females; mean age: 45.0±13.3 years; range, 18 to 75 years) who presented with the complaint of neck pain lasting for at least one month were included in this prospective, cross-sectional study. Data including concomitant dizziness, severity, and quality of life (QoL) impact of vertigo (via Numeric Dizziness Scale [NDS]), QoL (via Dizziness Handicap Inventory [DHI]), mobility (via Timed Up-and-Go [TUG] test), balance performance [via Berg Balance Scale [BBS]), and emotional status (via Hospital Anxiety- Depression Scale [HADS]) were recorded. Results: Dizziness was evident in 40.1% of the patients. Myofascial pain syndrome (MPS) was the most common etiology for neck pain (58.5%) and accompanied with cervicogenic dizziness in 59.7% of the patients. ...
Osteoporosis is a silent, asymptomatic disease until a fragility fracture is sustained. Fractures... more Osteoporosis is a silent, asymptomatic disease until a fragility fracture is sustained. Fractures greatly affect the physical functioning and health-related quality of life and are associated with increased mortality and morbidity rates. Furthermore, once a fragility fracture occurs, the patient is more susceptible to sustain further fractures. Repeated falls are the main causes of fractures in patients with osteoporosis. The management of osteoporosis postfracture is a combination of medical treatment, nutritional interventions, and rehabilitation in order to improve activities of daily living to prevent falls and increase safety while reducing the loss of bone mass. In this article the principles of fracture prevention and physical rehabilitation of patients with osteoporosis postvertebral and hip fragility fractures will be discussed, as well as the rehabilitation management to prevent further falls and fractures.
During the acute and chronic phase of spinal cord injury (SCI) bone turnover and structure are af... more During the acute and chronic phase of spinal cord injury (SCI) bone turnover and structure are affected. Bone mineral density of lower limbs is decreased up to 28%-50% below that of age-matched peers at 12-18 mo post injury. Coexisting secondary etiologies of osteoporosis may be present, and during ageing additional loss of bone occurs. All these compose a complex canvas of bone impairment after spinal cord injury and make the therapeutical approach challenging. The risk of fragility fractures is increased after the 2nd decade post SCI affecting the functionality and quality of life of individuals with SCI. Diagnostic flaws, lack of a ranking system to categorize the degree of bone impairment similar to the one of World Health Organization, and evidence-based clinical guidelines for management in SCI requires interdisciplinary cooperation and appropriate planning of future research and interventions. Spinal Cord Section of Hellenic Society of Physical Rehabilitation Medicine convened an expert panel working group on bone and spinal cord injury at the Pan-Hellenic Congress 2018 of PRM in Athens Greece, to establish an evidence-based position statement for bone loss in individuals with SCI of traumatic or non-traumatic etiology. This was reviewed by an International Task Force and used to create S1 Guidelines. This first version S1 guideline will work towards to provide help with prophylactic basic osteoporosis therapy diagnostic and therapeutic decisions in acute and chronic phase and rehabilitation countermeasures against osteoporosis related with spinal cord injury.
The effects of caregiver burden during the inpatient rehabilitation period have not yet been inve... more The effects of caregiver burden during the inpatient rehabilitation period have not yet been investigated. The purpose of this study was to evaluate the burden on stroke survivors' caregivers during the inpatient rehabilitation period, and to compare the associations of robot-assisted gait training and conventional therapy with caregiver burden. Our randomized, crossover, prospective study included 63 stroke survivors and their caregivers, who were randomly assigned to one of two groups. The patients in group I received robot-assisted gait training for 2 weeks, followed by conventional therapy for a further 2 weeks. The patients in group II received conventional therapy for 2 weeks followed by robot-assisted gait training for a further 2 weeks. The caregiver burden inventory, beck depression index, and beck hopelessness scale were administered to the caregivers at day 0, on the “switch day” (day 15), and day 30. Before inpatient rehabilitation, 18 (35%) of the caregivers had somewhat elevated scores on the caregiver burden inventory; however, at the end of rehabilitation, 42 (66.6%) of the caregivers were in a high-burden state. The caregiver burden inventory scores differed significantly between baseline and the end of rehabilitation in both groups. Caregiver depression scores also increased significantly in both groups (p < 0.0001), while hopelessness scores increased only in group II (p = 0.027). Caregiver burden increased during the inpatient stroke rehabilitation period. During inpatient rehabilitation, both robot-assisted gait training and conventional therapy increased caregiver burden. ClinicalTrials.gov Number NCT03535467, First Posted: 24 May 2018.
Gebelikte bel ağrısı, gebeliğe bağlı gelişen postural ve hormonal değişiklikler sonrası ortaya çı... more Gebelikte bel ağrısı, gebeliğe bağlı gelişen postural ve hormonal değişiklikler sonrası ortaya çıkan ve gebelikte en sık görülen kas iskelet sistemi semptomudur. Gebelikte bel ağrısına neden olan durumlar; pelvik relaksasyon, lomber diskopati, spondilolistezis, koksidini ve postüral bel ağrısı olarak sıralanabilir (1). Sıklıkla ikinci ve üçüncü trimesterde ağrı belirginleşir. Bel ağrısı ile başvuran gebede önemli olan ağrının lokalizasyonu ve yayılımıdır. Siyatalji, spinal sinir kökü basısına işaret eder ve siyatik sinir trasesine uyan ağrı ile başvuran gebede ilk akla gelmesi gereken patoloji lomber disk herniasyonu (LDH) olmalıdır (2). Semptomatik LDH 1-25/10,000 gibi daha nadir olarak karşımıza çıkmaktadır. Gebeliğin LDH için bağımsız bir risk faktörü olduğu ve var olan disk herniasyonunu kötüleştirebildiği bildirilmektedir (1). Kalçanın geçici osteoporozu (KGO) ise kalça ağrısının spontan başlayıp, zamanla ortadan kalktığı ve femur başında geç beliren osteoporoz görünümü ile karakterize nadir görülen bir klinik tablodur (3). İlk 1959'da üçüncü trimesterde olan üç gebede "kalçanın geçici demineralizasyonu" olarak Curtiss ve Kincaid tarafından tanımlanmıştır. 1967'de Duncan yük taşıyan eklemlerde ardı sıra gelişen poliartiküler artralji için "gezici bölgesel osteoporoz" tanımını kullanmış, 1968'de Lequesne tarafından "KGO" şeklinde isimlendirme yapılmıştır. İdiyopatik bölgesel osteoporoz, geçici ağrılı osteoporoz, geçici osteopeni, algodistrofi gibi tanımlamalar kullanılsa da günümüzde en yaygın kullanılan KGO ve geçici kemik iliği ödemi sendromudur (4). Sıklıkla 40-60 yaşlarındaki orta yaşlı erkeklerde ve gebeliğin üçüncü trimesterindeki kadınlarda görülmektedir. Bilateral
Background Unsuitable samples are common problem for laboratories. The blood collection tubes nee... more Background Unsuitable samples are common problem for laboratories. The blood collection tubes need to be validated or verified prior to their being used in the routine laboratory for reducing this situation. Objective We aim to compare the technical qualifications of routinely used BD Vacutainer® Serum Separator Tubes™ II Advance Plus with BD Vacutainer® Barricor™ LH Plasma Tubes for local technical validation. Materials and methods Apparently healthy 150 voluntary subjects were enrolled in the study. Samples were collected in two separated tubes by a single phlebotomist. Twelve quality indicators were used to compare these two different types of tubes for local technical validation. Differences (%) between them were calculated with the formula proposed by EFLM. In case of any difference of less than 1% for each indicator, the evaluated tube was considered as non-inferior. Results Indicators, such as tubes with physical defects, that fail to create vacuum, not properly fitting into ...
Karahan ve ark. D Vitamin ve Kas İskelet Sistemi Ağrıları Öz Objective: In this study, it was aim... more Karahan ve ark. D Vitamin ve Kas İskelet Sistemi Ağrıları Öz Objective: In this study, it was aimed to evaluate the relationship between vitamin D level and pain severity, localization and duration in patients with non-specific musculoskeletal pain. Materials and Methods: Patients who applied to physical medicine and rehabilitation outpatient clinics due to non-specific muscle pain in 19 centers in Turkey were retrospectively screened. Three thousand four hundred fourpatients were included in the study, whose pain level was determined by visual analog scale (VAS) and the painful region, duration of pain and vitamin D level were reached. D group was found to be D deficient (group 1) when 25 (OH)D level was 20 ng/mL or less and group D 2 (vitamin D deficiency) was higher than 30 ng/mL (group 3). The groups were compared in terms of pain duration, localization and severity. In addition, the correlations of pain localization, severity and duration with vitamin D levels were examined. Results: D vitamin deficiency was detected in 2202 (70.9%) of 3 thousand four hundred and four registered patients, and it was found that vitamin D deficiency in 516 (16.6%) and normal vitamin D in 386 (12.4%). The groups were similar in terms of age, body mass index, income level, duration of complaint, education level, family type and working status (p>0.05). There was no statistically significant difference between groups in terms of VAS, pain localization and duration scores (p>0.05). Conclusion: Our study shows that vitamin D deficiency in patients with nonspecific musculoskeletal pain is not associated with the severity and duration of pain.
Study design This was a single-centre, retrospective, descriptive, hospital-based study in person... more Study design This was a single-centre, retrospective, descriptive, hospital-based study in persons with spinal cord injuries (SCI) patients. Objectives To study the incidence and characteristics of heterotopic ossification (HO) after SCI. Setting The in-patient services of the Department of Physical Medicine and Rehabilitation of a tertiary care institute in India between January 2001 and December 2017. Methods Medical records of all consecutive patients with diagnosis of SCI in the age group of 15-60 years were reviewed for presence of HO (diagnosed by clinical signs, laboratory investigations (ALP, ESR and X-rays)) and characteristics of HO. R-Ver 3.4.2 was used for analysis and correlations. Results were considered significant at P < 0.05. Results A total of 303 patients satisfied inclusion criteria. Nineteen individuals (6.3%) had developed HO. Seven (37%) were diagnosed within 3 months of SCI. Twelve (63%) patients developed unilateral HO. The most common site for HO was hip joint (73%). A significant association was found between the presence of a pressure ulcer and development of HO (P = 0.01). Conclusions The incidence of HO was 6.3% in our institution and the hip joint is the most common site. Due to the presence of limited treatment options it is important to diagnose HO early in patients with SCI based on clinical features and later confirmed with laboratory tests and imaging.
The purpose of this study was to compare the effects of different injection technique guidance wi... more The purpose of this study was to compare the effects of different injection technique guidance with electrical stimulation (ES) vs ultrasonography (USG) of botulinum toxin A injection (BoNT A) in post-stroke patients with plantar flexor spasticity. Forty chronic post-stroke patients with plantar flexor spasticity and who were able to walk were included in the study. They were randomized into two groups: in 20 patients the BoNT A injection was applied with the guidance of ES and in 20 patients with the guidance of USG by the same physician. Gastrocnemius, soleus, and tibialis posterior were injected. Spasticity was evaluated by ashworth scale; the functional status was evaluated by ankle goniometry for range of motion, Brunnstrom stages, Barthel Index, and 10-m walk test before the treatment, 2nd week, and 3rd month after the treatment. Statistical significance was defined as p < 0.05. Two groups were similar in respect to demographical and clinical features. In both groups, walking speed and range of motion increased significantly after the treatment. When the two groups were compared at 3rd month after the treatment; range of motion of the ankle joint plantar flexion and dorsiflexion when knee in extension showed a significant difference between the two groups. Ashworth scale, Brunnstrom stages, Barthel index, walking speed tests, and other ankle goniometry for range of motion showed no statistically significant difference between two groups. We can conclude that USG and ES guidence are both effective injection techniques when applying BoNT A to ankle plantar flexor muscles.
Background: Review of the literature clearly reveals that little is known about the association b... more Background: Review of the literature clearly reveals that little is known about the association between functional and mental status, and Lower Urinary Tract Dysfunction (LUTD) in patients with stroke. Objective: The aim of this study was to assess functional and mental status in stroke patients and to identify possible associations with the prevalence, severity and bother of LUTD. Material and methods: This study was designed as a cross-sectional study and included 260 stroke patients enrolled from six different hospitals in Turkey. The patients were questioned using the Danish Prostatic Symptom Score (DAN-PSS) Questionnaire to evaluate LUTD, and evaluated using the Modified Barthel Index (MBI), Incontinence Quality of Life Questionnaire (I-QoL), and the Mini Mental State Examination (MMSE). Results: At least one LUTD finding was reported in 243 (93.5%) patients; the most commonly encountered complaint in these patients was nocturia (75.8%). The mean MBI, MMSE, and I-QoL scores were found to be significantly lower in LUTD (+) patients compared to LUTD (−) patients (p = 0.000, p = 0.005, and p < 0.01, respectively). Similarly all parameters (MBI, MMSE, and I-QoL scores) assessed were found to be significantly lower for patients with urinary incontinence than those without incontinence (p = 0.000, p = 0.000, and p < 0.01, respectively). Conclusion: LUTD is a common problem in patients with stroke. LUTD is associated with poorer cognitive and functional status and the quality of life in these patients. We, therefore, suggest that bladder dysfunction should not be overlooked during rehabilitation of stroke patients.
Objective: To assess the impact of spasticity severity as well as socio-demographic and clinical ... more Objective: To assess the impact of spasticity severity as well as socio-demographic and clinical factors on quality of life (QOL) and to identify factors predicting poor QOL among patients with spinal cord injury (SCI) Design: Descriptive cross-sectional study. Setting: Tertiary care clinic in Istanbul, Turkey. Participants: A total of 110 patients with SCI (mean (SD) age: 43.8 (14.7) years, 58.2% were males) were enrolled. Assessments: The American Spinal Injury Association (ASIA) Impairment Scale (AIS), Modified Ashworth Scale (MAS) and Turkish version of the World Health Organization Quality of life questionnaire (WHOQOL-BREF) were utilized to determine the SCI category, severity of spasticity and QOL scores, respectively. Outcome measures: The WHOQOL-BREF scores were evaluated with respect to the severity of spasticity, aetiology and duration of SCI, AIS category and method of bladder management. Results: The mean (SD) physical health (41.9 (15.3) vs. 46.5 (10.9), P = 0.029), social relationships (45.6 (20.2) vs. 53.8 (17.3), P = 0.025) and total WHOQOL-BREF scores were significantly lower in patients with more severe spasticity. Multivariate linear regression analysis revealed that severity of spasticity was a significant predictor of decreased WHOQOL-BREF total scores, physical domain scores and social relations domain scores by 11.381 (P = 0.007), 11.518 (P = 0.005) and 17. 965 (P = 0.004), respectively. Conclusion: In conclusion, addressing QOL in relation to severity of spasticity for the first time among Turkish SCI patients, our findings revealed a negative impact of the spasticity severity on the WHOQOL-BREF scores, particularly for physical health and social relationship domains.
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