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Coexistence of rheumatoid arthritis (RA) and ankylosing spondylitis (AS) is rare. Tumor necrosis factor (TNF) inhibitor has been highly successful in controlling inflammation in many patients with AS or RA. Rituximab, which is a chimeric anti‐CD20 monoclonal antibody, has been proven effective in RA. Whether rituximab may be effective in AS is presently unclear. Here we report the 18 months follow‐up result of a coexisting AS and RA TNF inhibitor failed patient that was treated successfully with rituximab. [ABSTRACT FROM AUTHOR]

Background: There has been a growing interest in the use of robotic therapy to improve walking ability in individuals following stroke. Objectives: The aim of this retrospective study was to compare conventional physiotherapy (CP) with robotic training (RT) combined with CP and to measure the effects on gait, balance, functional status, cognitive function, and quality of life in patient with stroke. Methods: We retrospectively identified 107 cases of new cerebral stroke. They were allocated into 2 groups. In the RT group (n = 36), patients received RT (Lokomat; 2 times per week) combined with CP (3 times per week) for at least 30 sessions. In the CP group (n = 71), patients received a program at least 30 sessions, 5 times per week. The evaluation parameters included modified Ashworth Spasticity Scale (MASS), Brunnstrom Recovery Scale (BRS), Functional Independence Measure (FIM), Functional Ambulation Categories (FAC), Berg Balance Scale (BBS), Mini-Mental State Examination (MMSE), and Short Form-36 (SF-36) Health Survey. Results: Posttreatment results showed significant improvements for all parameters (except lower extremity MASS scores) in both groups. However, when we compared the percentage changes of parameters at discharge relative to pretreatment values, improvements in FIM, MMSE, and all subparts of SF-36 were better in the RT group (P < .05). Comparison of posttreatment evaluation parameters for categorical variables showed that the lower extremity categories in the BRS were significantly better in the RT group than the CP group (P < .05). Conclusion: RT combined with CP produced better improvement in FIM, MMSE, BRS lower extremity categories, and all subparts of SF-36 of the patients with subacute and chronic stroke (up to 1 year) than the CP program. [ABSTRACT FROM AUTHOR]

Ankylosing spondylitis (AS) is a chronic systemic inflammatory disease that affects mainly the axial skeleton and causes significant pain and disability. Aquatic (water-based) exercise may have a beneficial effect in various musculoskeletal conditions. The aim of this study was to compare the effectiveness of aquatic exercise interventions with land-based exercises (home-based exercise) in the treatment of AS. Patients with AS were randomly assigned to receive either home-based exercise or aquatic exercise treatment protocol. Home-based exercise program was demonstrated by a physiotherapist on one occasion and then, exercise manual booklet was given to all patients in this group. Aquatic exercise program consisted of 20 sessions, 5× per week for 4 weeks in a swimming pool at 32-33 °C. All the patients in both groups were assessed for pain, spinal mobility, disease activity, disability, and quality of life. Evaluations were performed before treatment (week 0) and after treatment (week 4 and week 12). The baseline and mean values of the percentage changes calculated for both groups were compared using independent sample t test. Paired t test was used for comparison of pre- and posttreatment values within groups. A total of 69 patients with AS were included in this study. We observed significant improvements for all parameters [pain score (VAS) visual analog scale, lumbar flexion/extension, modified Schober test, chest expansion, bath AS functional index, bath AS metrology index, bath AS disease activity index, and short form-36 (SF-36)] in both groups after treatment at week 4 and week 12 ( p < 0.05). Comparison of the percentage changes of parameters both at week 4 and week 12 relative to pretreatment values showed that improvement in VAS ( p < 0.001) and bodily pain ( p < 0.001), general health ( p < 0.001), vitality ( p < 0.001), social functioning ( p < 0.001), role limitations due to emotional problems ( p < 0.001), and general mental health ( p < 0.001) subparts of SF-36 were better in aquatic exercise group. It is concluded that a water-based exercises produced better improvement in pain score and quality of life of the patients with AS compared with home-based exercise. [ABSTRACT FROM AUTHOR]

Animal studies suggest that tumor necrosis factor (TNF) alpha blockers may pass to the inner ear in adequate concentration. In this prospective study, we aimed to evaluate the effect of infliximab on the inner ear hearing function in patients with ankylosing spondylitis (AS) and rheumatoid arthritis (RA). The patients with high disease activity, who were planned to begin infliximab for therapy by physical medicine and rehabilitation department, were referred to ear-nose-throat clinic for consultation. After physical and otoscopic examination, audiological tests were performed. Air conduction thresholds between 250 and 8,000 Hz, bone conduction thresholds between 500 and 4,000 Hz, pure tone average, speech discrimination scores, distortion product otoacoustic emission (DPOAE) were used to evaluate the hearing function. The tests were repeated 2 and 6 months after the initiation of the drug 'infliximab.' A total of 44 ears of 22 patients (17 males and 5 females) were evaluated. Fifteen patients had a diagnosis of AS, and seven patients had RA. After initiation of infliximab therapy, statistically significant improvement was observed in disease activity scores [Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for AS, Disease Activity Score 28 (DAS-28) for RA] after 2 and 6 months ( p < 0.05). We did not find any statistically significant difference between the air conduction thresholds, bone conduction thresholds, pure tone average, speech discrimination scores, and measurements of DPOAE before the initiation of treatment and after 2 and 6 months ( p > 0.05). Any problem about the balance, vertigo, or dizziness was not reported from the patients during the treatment period. As a result, our study showed that there was no notable change or deterioration in the hearing function of the patients with AS and RA who were treated with infliximab. Further studies with higher number of patients with AS and RA and also with different TNF alpha inhibitors are needed to make more valid conclusion. [ABSTRACT FROM AUTHOR]

Low back pain (LBP) is an important clinical, social, and public health problem. Balneotherapy is a type of therapy by hot or warm waters containing minerals. The aim of this study was to investigate the effects of balneotherapy with exercise on pulmonary functions, aerobic exercise capacity, resting metabolic rate, body fat %, psychosocial condition and its efficiency on therapy in patients with LBP. Balneotherapy and exercise program were applied to group 1 (14 female, 9 male). Only an exercise program was applied to group 2 (13 female, 8 male). The measurements of maximal oxygen consumption, resting metabolic rate, pulmonary function tests, body fat %, Oswestry disability index, visual analog scale, quality of life measure, symptom checklist-90-revised, the hospital anxiety and depression scale, spine joint mobility tests from all participants were performed before and after the treatment. An improvement was found in pulmonary function test (maximal volunteer ventilation), aerobic exercise capacity, pain and disability scores, spine mobility (extension distance), quality of life, and all psychiatric symptoms (except anxiety) in group 1 following therapy period. Also some improvements were observed in body fat percentage, pulmonary function tests (forced vital capacity, forced expiratory volume in 1 second, forced expiratory flow at 25% to 75% vital capacity and peak expiratory flow), and other spine joint mobility tests before and after therapy in group 1, though they were not statistically significant. Balneotherapy with exercise could be alternative therapy methods in patients with LBP. [ABSTRACT FROM AUTHOR]

The efficacy of low-level laser therapy (LLLT) in myofascial pain syndrome (MPS) seems controversial. A prospective, double-blind, randomized controlled trial was conducted in patients with chronic MPS in the neck to evaluate the effects of low-level 830-nm gallium arsenide aluminum (Ga–As–Al) laser therapy. The study group consisted of 64 MPS patients. The patients were randomly assigned into two groups. In group 1 ( n = 32), Ga–As–Al laser treatment was applied over three trigger points bilaterally for 2 min over each point once a day for 15 days during a period of 3 weeks. In group 2 ( n = 32), the same treatment protocol was given, but the laser instrument was switched off during applications. All patients in both groups performed daily isometric exercise and stretching exercises for cervical region. Parameters were measured at baseline and after 4 weeks. All patients were evaluated with respect to pain (at rest, movement, and night) and assessed by visual analog scale, measurement of active range of motion using an inclinometer and a goniometer, and the neck disability index. In both groups, statistically significant improvements were detected in all outcome measures compared with baseline ( p < 0.05). However, no significant differences were obtained between the two groups ( p > 0.05). In conclusion, although the laser therapy has no superiority over placebo groups in this study, we cannot exclude the possibility of effectivity with another treatment regimen including different laser wavelengths and dosages (different intensity and density and/or treatment interval). [ABSTRACT FROM AUTHOR]

Bilateral symmetric calcification involving striatum pallidum with or without deposits in the dentate nucleus, thalamus and white matter is commonly referred to as Fahr's syndrome. Symptoms of the disorder may include deterioration of motor function, spasticity, spastic paralysis, dysarthria, dementia, seizures, headache and athetosis. The clinical and imaging abnormalities are restricted to the central nervous system (CNS). We report an unusual association of Fahr's syndrome with polyarticular juvenile idiopathic arthritis in a girl. [ABSTRACT FROM AUTHOR]

Objectives: Musculoskeletal system (MSS) knowledge and clinical skills have been shown to be an area of weakness in medical education and practitioners, and neglected in daily clinical practice. The purpose of this study was to evaluate and compare MSS knowledge and skills of the third and sixth year medical students. Methods: The study included 41 volunteers from third year and 35 volunteers from sixth year medical students. Participants were asked to mark long head of biceps brachii muscle tendon (BTLH), lateral epicondyle (LE), greater trochanter (GT) and medial knee joint space (MK) areas were with physical examination. After students marked the choosen anatomical landmarks one by one on the same subject, the accuracy of the results were checked with ultrasonography. Results: Total success rate was 51.8% in third year students while it was 68.6% in sixth year students and the difference between two groups was statistically significant (p=0.004). Students performance to locate LE and GT was high but they were failed to locate BTLH and MK. Conclusion: This study demonstrated that medical students improved their MSS skills that they obtained in preclinical education period, during clinical education period. Nevertheless this improvement was not adequate. Regarding increasing number of patients admitting to hospitals with the complaints of MSS, medical faculties should focus on improving MSS clinical skills teaching and develope effective strategies to meet this requirements. This research is puplished in Kocatepe Medical Journal: A. M. Ulaşli, F. Yaman, Y. Gönül, H. Gökalp, M. T. Özen, H. Rüzgar, Y. Gülsarı, and Ü. Dündar, "Assessment of Musculoskeletal System Knowledge and Skills of the Medical Students," vol. 15, no. 2, pp. 147-151, 2014. [ABSTRACT FROM AUTHOR]