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Byline: U. Dundar, O. Solak, I. Yigit, V. Kavuncu Bilateral symmetric calcification involving striatum pallidum with or without deposits in the dentate nucleus, thalamus and white matter is commonly referred [...]

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]

STUDY DESIGN: This study was a prospective, randomized, controlled study. OBJECTIVE: To compare the effectiveness of aquatic exercise interventions with land-based exercises in the treatment of chronic low back pain (CLBP). SUMMARY OF BACKGROUND DATA: Land-based exercise and physiotherapy are the main treatment tools used for CLBP. Clinical experience indicates that aquatic exercise may have advantages for patients with musculoskeletal disorders. METHODS: A total of 65 patients with CLBP were included in this study. Patients were randomly assigned to receive aquatic exercise or land-based exercise treatment protocol. Aquatic exercise program consisted of 20 sessions, 5 x per week for 4 weeks in a swimming pool at 33 degrees C. Land-based exercise (home-based exercise) program were demonstrated by a physiotherapist on one occasion and then they were given written advice The patients were assessed for spinal mobility, pain, disability, and quality of life. Evaluations were performed before treatment (week 0) and after treatment (week 4 and week 12). RESULTS: In both groups, statistically significant improvements were detected in all outcome measures (except modified Schober test) compared with baseline. However, improvement in modified Oswestry Low Back Pain Disability questionnaire and physical function and role limitations due to physical functioning subpart of Short-Form 36 Health Survey were better in aquatic exercise group (P < 0.05). CONCLUSION: It is concluded that a water-based exercises produced better improvement in disability and quality of life of the patients with CLBP than land-based exercise. [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]

In Parkinson’s disease (PD), a resting tremor of the thumb may affect the flexor pollicis longus (FPL) and influence hand functions. We investigated the relationship between FPL tendon thickness and hand function in PD patients and compared these characteristics with those in healthy controls.

In this study, test samples prepared from Anatolian chestnut (Castanea sativa) wood were first exposed to heat treatment at 130, 145, 160, 175, 190 and 205 ºC for 3, 6, 9 and 12 hours. Then the values of the samples of the modulus of rupture (MOR) and modulus of elasticity (MOE) were determined and evaluated by multiple variance analysis. The aim of this study was to establish the effects of heat treatment on the MOR and MOE values of wood samples by using fuzzy logic classifier. Secondly, input and output values and rule base of the fuzzy logic classifier model were built by using the results obtained from the experiment. The developed fuzzy classifier model could predict the MOR and MOE values of test samples at the accuracy levels of 92.64 % and 90.35 %, respectively. The model could be especially employed in manufacturing stages of timber industry.

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]

Background: Awareness of the value of aquatic exercise (AE) in the postoperative rehabilitation has increased, and several inherent advantages of AE, such as adjustment of both resistance and muscle strengthening parameters makes good rationale for its inclusion in postoperative rehabilitation. This study aimed to determine and compare the benefits of AE and land-based exercise (LBE) on pain, functionality, and quality of life after arthroscopic partial meniscectomy (APM)., Methods: This randomized controlled study included 30 middle-aged (35-50), physically active patients who were randomized into LBE (n = 15) and AE (n = 15) groups after APM for a degenerative meniscal tear. Visual analogue scale (VAS), Short Form-36 (SF-36), single-leg hop test and Lysholm questionnaire scores in addition to isokinetic muscle strength values were evaluated at baseline, at fourth week immediately after cessation of exercise program and at eighth week follow-up visits. The exercise sessions were conducted in 1-h sessions per day, three days a week for a total of four weeks., Results: Significant improvement was observed in the VAS, single-leg hop test, Lysholm questionnaire, and most of SF-36 subscale scores in both groups at both fourth and eighth follow-ups. Isokinetic dynamometer revealed significant improvement in the peak torque values for extension at angular velocities of 60° and 180° at both follow-ups in the AE group. LBE group showed significant improvement in the peak torque value for extension only at an angular velocity of 60° only at fourth week follow-up. There was no significant difference between groups for any of these parameters at any of the follow-ups., Conclusion: Both AE and LBE programs had significantly improved pain, function, isokinetic muscle strength, and quality of life in patients after APM. Either type of exercise is essential as part of the rehabilitation protocol for good clinical outcomes after APM and should not be neglected (level II)., Clinicaltrials Registration Number: NCT04925726., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2021 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Background: In task-oriented studies showed that the chronic pain is effective on dual tasks. Chronic pain is the main health problem that prevents mobility restriction and participation in most rheumatic diseases., Research Question: Do rheumatic diseases have an effect on dual task gait performance?, Methods: This comparative-descriptive study included 75 individuals who aged 18-65 years and divided in two groups as Rheumatic Disease Group (RG; 23 women, 14 men) and Control Group (CG; 20 women, 18 men). The individuals have a chronic pain (> 3.4 cm according to Visual Analogue Scale, VAS) and Standardized Mini Mental State Examination score above 24 were included in this study as the RG. The individuals who were did not have any known disease were included in the CG. The health status of RG was evaluated with the Arthritis Impact Measurement Scale 2 (AIMS-2). The 10-meter Walk Test was applied under single and dual task conditions (dual task cognitive, DT cognitive ; dual task motor, DT motor ) for assessing gait performance., Results and Significance: The mean age of the individuals in the study was 40.6 ± 11.34 years (RG=43.08 ± 11.30; CG=38.18 ± 11.00). There was a significant difference in favor of CG between the groups both in terms of gait speed in DT cognitive and its cost (p < 0.05). VAS scores correlate with single and DT cognitive and DT motor gait parameters (p < 0.05). Many subdivisions of AIMS-2 were associated with single, DT cognitive and DT motor gait parameters (p < 0.05). This study concluded that rheumatic diseases may reduce gait performance in concurrent motor-cognitive dual task conditions due to chronic pain. Single and dual task gait parameters may be related with psychosocial factors. Therefore, applications including pain control and biopsychosocial approach may be beneficial in the management gait disturbances and falls due to a rheumatic disease., (Copyright © 2022 Elsevier B.V. All rights reserved.)

The aim of this study was to perform a placebo-controlled assessment of the short- and long-term efficiency of high-intensity laser therapy (HILT) in treatment of subacromial impingement syndrome (SAIS). Sixty-three patients (32 in HILT + exercise and 31 in sham HILT + exercise group) who were diagnosed with SAIS were included. The assessments were performed before (baseline, 0) and after treatment (3rd week/12th week). Active range of motion (ROM) with goniometric measurement, pain with visual analog scale (VAS), shoulder function with Constant-Murley score (CMS), quality of life with SF-36 (short-form 36) health survey, muscle strength using isokinetic device (including peak torque level measurements at shoulder internal rotation (IR) and external rotation (ER) at 120, 180, and 210 degrees) were assessed. Significant improvements were determined in the assessments at the 3rd and 12th week controls in both HILT and control groups. In the comparison of the values of the groups (3rd/12th week), the HILT group had a statistically significant improvement compared with the placebo group; in the active shoulder flexion, IR, and ER ROM measurements; in VAS scores; in CMS activities of daily living, ROM, strength and total scores; in all the sub-parameters of SF-36; and in IR 120,180, 210 and ER 120,180 degree/s peak torque values of isokinetic measurements. In the comparison of both groups, HILT + exercise treatment is more effective in reducing pain and increasing the ROM, functioning, quality of life, and the muscular strength assessed with isokinetic in the short and long term., (© 2021. The Author(s), under exclusive licence to Springer-Verlag London Ltd. part of Springer Nature.)

To evaluate the effect of high-intensity laser therapy (HILT) in patients with calcaneal spur. The patients were randomized to receive either HILT + exercise (n = 21) (five times a week for a period of 3 weeks) or placebo HILT + exercise (n = 21) (five times a week for a period of 3 weeks). Pain severity (with visual analog scale (VAS) and with Roles and Maudsley score (RMS)), functionality (with Foot and Ankle Outcome Score (FAOS)), plantar pressure measurement, and quality of life (with short form-36 (SF-36)) of the patients were evaluated at baseline, at 4 weeks, and 12 weeks. A significant improvement in the VAS (p < 0.001), RMS (p < 0.001), and most of the SF-36 subgroup scores (p < 0.05) and most of the FAOS subgroup scores (p < 0.05) at 4 and 12 weeks after treatment was achieved in both groups. Besides, there was no significant difference in VAS (p > 0.05) and RMS (p > 0.05) between the groups. FAOS symptoms (p = 0.022) and quality of life (p = 0.038) subgroups were higher in the placebo group at 12 weeks. Significant improvements were observed in dynamic pedographic measurements in the HILT group (p < 0.05), and dynamic measurement values were significantly higher in the HILT group compared to placebo group (p < 0.05). Although the evaluation parameters, except dynamic pedographic measurements, have improved in both groups, our study results showed no superiority of HILT over placebo. To conclude, when the main complaint is pain in patients, only exercise therapy can be an economical, practical, and reliable treatment.

Study Design: This study was a prospective, randomized, controlled study., Objective: The aim of this study was to determine whether transcutaneous electrical nerve stimulation (TENS) or interferential current (IFC) increase the effectiveness of neck stabilization exercises (NSEs) on pain, disability, mood and quality of life for chronic neck pain (CNP)., Summary of Background Data: Neck pain is one of the three most frequently reported complaints of the musculoskeletal system. Electrotherapies, such as IFC and TENS, have been applied solo or combined with exercise for management of neck pain; however, the efficacy of these combinations is unclear., Methods: A total of 81 patients with CNP were included in this study. Patients were randomly assigned into three groups regarding age and gender. First group had NSE, second group had TENS and NSE, and third group had IFC and NSE. Pain levels [visual analogue scale (VAS)], limits of cervical range of motion (ROM), quality of life (short form-36), mood (Beck depression inventory), levels of disability (Neck Pain and Disability Index), and the need for analgesics of all patients were evaluated before treatment, at 6th and 12th week follow-up. Physical therapy modalities were applied for 15 sessions in all groups. All participants had group exercise accompanied by a physiotherapist for 3 weeks and an additional 3 weeks of home exercise program., Results: According to the intragroup assessment, the study achieved its purpose of pain reduction, ROM increase, improvement of disability, quality of life, mood and reduction in drug use in all three treatment groups (P < 0.05). However, clinical outcomes at 6th and 12 th week had no significant difference among the three groups (P > 0.05)., Conclusion: TENS and IFC therapies are effective in the treatment of CNP patients. However, they have no additional benefit or superiority over NSE., Level of Evidence: 2.

Aim: Recent literature suggests that neuropathic pain (NP) and vitamin D deficiency can occur concurrently in patients with rheumatoid arthritis (RA). This study aimed to examine the development of NP in patients with RA and the relationship between NP and vitamin D., Methods: We used the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) questionnaire to evaluate NP in 93 patients with RA. Demographic and clinical data were obtained from patient files and interviews, and patients' serum vitamin D levels were recorded. Patients were requested to complete both the Short Form-36 survey and the Health Assessment Questionnaire., Results: Seventy-five of the eligible patients were female (80.6%), and 31 (33.3%) were diagnosed with NP according to the LANSS. There was a negative correlation between vitamin D levels and the LANSS score (P = 0.001). The prevalence of NP was 5.8 times higher among patients with serum vitamin D levels below 20 ng/mL than in patients with vitamin D levels ≥ 30 ng/mL. Based on the area under curve (AUC) values, we found that serum levels of vitamin D were a good predictor of NP diagnoses in patients with RA (AUC = 0.71)., Conclusion: We found that vitamin D deficiency was asssociated with increased NP in patients with RA. Although further research is needed to clarify the association between serum vitamin D levels and NP, our study raises awareness of the need to screen for vitamin D deficiency in RA patients with NP., (© 2017 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.)

Background: After the stroke, a number of changes occur in the neuromuscular system functions., Objective: To determine whether the water based exercise (WBE) program applied in combination with the land-based exercises (LBE) compared to LBE alone contributes to the stroke patients' motor functions, walking, balance functions and quality of life (QoL)., Methods: In total, 60 patients participated in this study. Patients were randomly divided into two groups. WBE therapy (3/week) + LBE (2/week) combination was applied to the patients in the study group (n = 30) for six weeks. LBE was applied to the control group (n = 30) 5/week for six weeks. Patients were evaluated before and after the treatment. Functional independence measurement, Berg balance scale, timed up and go test, and short form (SF) -36 assessment questionnaire were performed., Results: Posttreatment results showed significant improvements in all of the parameters (except SF - 36 pain parameter) in both groups. The improvement in the vitality parameter of SF-36 was higher in the study group (p < 0.05), and improvement in the BBS was significantly higher in the LBE group than the WBE group (p < 0.05)., Conclusion: Applying WBE together with the LBE (except SF-36 vitality sub-parameter) in patients with hemiplegia did not make any additional contribution to the application of LBE alone.

Background: The purpose of this study was to investigate the most important predictor isokinetic muscle strength determined by different angular velocities and contraction types (i.e. concentric and eccentric) for selected anaerobic power tests in volleyball players., Methods: Twenty male and ten female amateur volleyball players participated in this study. Selected anaerobic power tests included Wingate Anaerobic Test (WAnT), squat jump (SJ) and countermovement jump (CMJ). Peak torque values were obtained at 60, 120, 240˚/s for concentric contraction of quadriceps (Qconc) and Hamstring (Hconc) and at 60˚/s for eccentric contraction of quadriceps (Qecc) and Hconc., Results: Moderate to good correlations (r:0.409 to r:0.887) were found between anaerobic tests and isokinetic data including peak torque and total work of both Hconc and Qconc at 60, 120, 240°/s and Qecc at 60°/s (P<0.05). Qconc measured at each of 60, 120, 240°/s was found to be the only significant predictor for anaerobic tests in linear regression models (P<0.05). Correlation coefficient s for Qconc increased with increasing velocity for each of the anaerobic tests. Correlation coefficient of Qconc was highest for CMJ followed by SJ and WAnT at the same angular velocity. As a distinctive feature, both Qecc and Hconc at 60˚/s were significantly predictors for CMJ and SJ., Conclusions: Qconc peak torque was the single significant predictor for WAnT, SJ and CMJ and strength of the relation increases with increasing angular velocity. However, both Qecc and Hconc were significant indicators for CMJ and SJ. Training with higher isokinetic angular velocities and with eccentric contraction is desirable in a training program that has a goal of improving anaerobic performance in volleyball players.

Lateral epicondylitis (LE) is a common disorder that causes pain on the outside of the elbow, as well as pain and weakness during gripping. In this prospective, randomized, controlled, assessor-blinded trial, we planned to investigate the effects of high-intensity laser therapy (HILT) in patients with LE and to compare these results with those of a brace and placebo HILT. Patients were randomly assigned to three treatment groups. The first group was treated with HILT. The second group (sham therapy group) received placebo HILT, while the third group (brace group) used the lateral counterforce brace for LE. The patients were assessed for grip strength, pain, disability, and quality of life. Outcome measurements and ultrasonographic examination of the patients were performed before treatment (week 0) and after treatment (after 4 and 12 weeks). HILT and brace groups showed significant improvements for most evaluation parameters (pain scores, grip strength, disability scores, and several subparts of the short-form 36 health survey (physical function, role limitations due to physical functioning, bodily pain, general health, and vitality)) after treatment (after 4 and 12 weeks). However, the improvements in evaluation parameters of the patients with LE in HILT and brace groups were not reflected to ultrasonographic findings. Furthermore, comparison of the percentage changes of the parameters after treatment relative to pretreatment values did not show a significant difference between HILT and brace groups. We conclude that HILT and splinting are effective physical therapy modalities for patients with LE in reducing pain and improving disability, quality of life, and grip strength.

Objective: The aim of this study was to assess the ultrasonographic (US) findings of pes anserinus tendon and bursa in patients with knee osteoarthritis (OA) with or without clinical pes anserinus tendinitis bursitis syndrome (PATBS)., Methods: A total of 157 female patients with the diagnosis of knee OA on both knees (314 knees), and 30 age, and body mass index- matched healthy female controls without knee pain (60 knees), were included in the study. PATBS was clinically diagnosed. US evaluation parameters were the measurement of the thickness of pes anserinus tendon insertion region (PA) and examination of the morphologic intratendinous PA tissue characteristics and pes anserinus bursitis (PAB). Radiographic knee osteoarthritis graded I-IV according to Kellgren and Lawrence (KL) for each knee was recorded. Pain and functional status were assessed by the Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)., Results: There were 183 PATBS (58.3%) clinical diagnoses among the 314 knees with OA. The mean thickness of PA in the patients with knee OA graded 1,2,3,4 with/without PATBS was significantly greater than the controls (p = 0.001). The mean thickness of PA in knees with OA KL graded 3 and 4 with/without PATBS, was greater than knees with OA KL graded 1 and 2 with/without PATBS (p < 0,05) (except knee OA KL graded 2 with PATBS versus knee OA KL graded 4 without PATBS).The knee OA KL graded 1,2,3,4 with PATBS had significantly more PAB and less loss of normal fibrillar echotexture of PA compared to controls and knees with OA KL graded 1,2,3,4 without PATBS (p < 0.05). The VAS scores of knees with OA KL graded 3, 4 with PATBS were significantly greater than those of knees with OA KL graded 3,4 without PATBS (p < 0.05). PA thickness was significantly associated with the KL grade (r: 0.336, p:0.001) and PATBS (r: 0.371, p < 0.001)., Conclusion: It is concluded that the mean thickness of PA in knees with OA with/without PATBS was significantly greater than the controls. The mean thickness of PA in knees with OA, KL graded 3 and 4 with/without PATBS, was greater than in knees with OA KL graded 1 and 2 with/without PATBS. The knee OA with PATBS had significantly more PAB, less loss of normal fibrillar echotexture of PA, and higher VAS scores compared to the knees with OA without PATBS. US can serve as a useful diagnostic tool for detection of PATBS in knee OA.

Myofascial pain syndrome (MPS) of the trapezius muscle is one of the main causes of neck pain. In this randomized, double-blind study, we evaluated the effects of high-intensity laser therapy (HILT) in female patients with chronic MPS of the trapezius muscle. The patients were assigned to two groups. The HILT group was treated with HILT and exercise, and the sham therapy group was treated with placebo HILT and exercise. The patients were assessed for pain, cervical active range of motion, disability, and quality of life. Evaluations were performed before treatment (week 0) and after treatment (weeks 4 and 12). Both groups showed significant improvement in all parameters at weeks 4 and 12. However, in a comparison of the percentage changes in the parameters at weeks 4 and 12 relative to pretreatment values, the HILT group showed greater improvement in pain scores, the neck disability index, and several subparts of the short-form 36 health survey (SF-36) (physical functioning, role limitations due to physical functioning, bodily pain, general health perceptions, social functioning, and role limitations due to emotional problems) than did the sham therapy group. We conclude that HILT is an effective therapeutic method in the treatment of patients with chronic MPS of the trapezius muscle.

The vitamin D receptor (VDR) was the first candidate gene to be studied in relation to osteoporosis, and most attention has focused on polymorphisms situated near the 3' flank of VDR. The aim of this study was to investigate the association about VDR gene Apa I polymorphism with bone mineral density (BMD) in postmenopausal women with osteoporosis. We studied a total of 136 postmenopausal women with a mean age of 56.36 +/- 10.29 years. Among them, a total of 75 had osteoporosis, 37 had osteopenia, and 24 had normal BMD. Venous blood samples were obtained for evaluation of bone metabolism and genotyping. The VDR Apa I genotype was determined by polymerase chain reaction-restriction fragment length polymorphism. BMDs at the lumbar spine and hip were measured by dual-energy X-ray absorptiometry. Postmenopausal women with aa genotype had significantly lower BMD values (grams per centimeter square) at lumbar spines compared to persons with AA genotype. Also, postmenopausal women with AA genotype had significantly higher serum Ca level than the subjects with aa genotype. In conclusion, our result may indicate that VDR Apa I gene polymorphism may be responsible for a important part of the heritable component of lumbar spine BMD in postmenopausal women, possibly related to impaired calcium absorption from the bowel.

Screening studies indicate a prevalence of celiac disease (CD) of up to 1% in populations of European ancestry, yet the majority of cases remain undiagnosed. One of the common complication of CD is intestinal osteopathy or osteoporosis [bone mineral density (BMD) based diagnosis]. Available data regarding the prevalence of CD in the patients with osteoporosis are limited and controversial. The objective of this study was to perform serological testing to screen for CD among postmenopausal women with osteoporosis. We studied 192 postmenopausal women with low BMD with a mean age of 62.75 +/- 8.58 years. Among the patients, a total of 137 had osteoporosis and 55 had osteopenia. Venous blood samples were obtained for serological screening of CD and evaluation of bone metabolism. The serological screening protocol consisted of determining serum level of IgA antigliadin antibodies (AGA), IgG-AGA, IgA endomysial antibody (EMA), IgG-EMA. Subjects who were positive for both IgA-AGA and IgA-EMA were classified as having CD. Bone metabolism was evaluated by serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone, 25 (OH) vitamin D, osteocalcin, serum C-telopeptide cross-linked collagen type I levels. Of the 192 patients evaluated, only one (0.5%) was found to have positive for both IgA-AGA and IgA EMA tests and accepted as having CD. Prevelance of CD in postmenopausal women with low BMD (0.5%) did not differ from prevelance of CD in normal healthy population (0.3-1%). BMD values at proximal femur level were significantly lower in IgA-AGA (+) patients when compared to IgA-AGA (-) patients. However, the mean levels of bone metabolism markers were found similiar in both IgA-AGA (+) and (-) patients. In conclusion, the results of our study suggest that there is no need for routine screening of CD in postmenopausal women with osteoporosis.

Familial Mediterranean fever (FMF) has episodic or subclinical inflammation that may lead to a decrease in bone mineral density (BMD). The aim of this study was to evaluate the effect of FMF on bone metabolism and to investigate the factors that can influence bone metabolism, such as body mass index (BMI), mutations in Mediterranean fever (MEFV) gene, osteoprotegerin (OPG), leptin and inflammatory cytokines, including interleukin (IL)-1beta, IL-6 and tumor necrosis factor-alpha (TNF-alpha). OPG, a soluble protein produced by osteoblasts, favors increased bone mass. Leptin may influence bone metabolism by acting on differentiated osteoblasts, having anabolic effects on bone. Thirty-one FMF patients in attack-free period (12 females and 19 males; mean age 31.4 +/- 9.3 years) and 18 healthy controls (11 females and 7 males; mean age 34.6 +/- 9.5 years) were compared according to the above parameters. BMD (g/cm(2)) and standard deviation scores (Z-score) were measured at the lumbar spine L(1)-L(4) (BMD-L(1-4)) and proximal femur by dual X-ray absorptiometry. Osteopenia is defined as a Z-score between -1 and -2.5 and osteoporosis is equal or below -2.5. FMF patients showed statistically significant reduction in BMD-L(1-4) and Z-score-L(1-4). Moreover, serum OPG concentration was significantly elevated in FMF patients. In contrast, MEFV gene mutations, leptin and the inflammatory cytokines did not differ between the patient and control groups. In conclusion, BMD was decreased and OPG was increased in our FMF patients. The high OPG levels may reflect a preventive mechanism against bone loss; namely, OPG might protect the FMF patients from excessive osteoporosis.

There is much evidence suggesting that the decline in ovarian function after menopause is associated with spontaneous increases in proinflammatory cytokines. Treatment with risedronate is accompanied by significant changes in bone turnover and bone mineral density. The objective of this study was to determine the effects of risedronate treatment on the level of serum cytokines including receptor activator of nuclear factor-kappaB ligand (RANKL) and osteoprotegerin among postmenopausal women with osteoporosis. The study group consisted of 61 postmenopausal women with osteoporosis. Patients were randomly divided in two groups: In group 1 (n = 41) postmenopausal women received oral risedronate (35 mg/week), calcium (1,000 mg/day), and vitamin D (400 IU/day) for 12 months. In group 2 (control group; n = 20) patients received only oral calcium (1,000 mg/day) and vitamin D (400 IU/day). Bone mineral density (BMD) of lumbar spine (L1-L4) and proximal femur were determined using dual X-ray absorptiometry at baseline and after one year. Venous blood samples were obtained for determination of serum cytokines including interleukin-1beta (IL-1beta), tumor necrosis factor-alpha (TNF-alpha), RANKL, osteoprotegerin, and markers of bone formation and resorption. Levels of serum cytokines were measured before therapy and after three and 6 months. Markers of bone metabolism were studied before therapy and after 6 months. In group 1 (risedronate plus calcium/vitamin D-treated patients), serum levels of RANKL and IL-1beta significantly decreased and the level of osteoprotegerin significantly increased after three and 6 months, but no significant difference was found in TNF-alpha level. In group 2, however, the level of serum cytokines did not change after three and 6 months. In cases of bone turnover, both markers of bone resorption and formation significantly decreased after 6 months in group 1. In conclusion risedronate could improve osteoporosis by increasing osteoprotegerin and reducing RANKL and IL-1beta.

Objective: We investigated the effectiveness of transcutaneous electrical nerve stimulation (TENS) therapy on pain during the first 24 hours after a cardiac surgical procedure., Methods: A total of 60 patients who had undergone median sternotomy (MS) for coronary artery bypass graft (n = 55) or valve repair surgery (n = 5) were randomized to receive TENS and pharmacologic analgesia, placebo TENS and pharmacologic analgesia, or pharmacologic analgesia alone (control group). For each group we recorded severity of pain, analgesic intake, and pulmonary complications. Pethidine HCL and metamizol sodium were administered for postsurgical analgesia., Results: Pain after MS was measured on a 10-point visual analogue scale (VAS). Mean scores in the TENS, placebo TENS, and control groups, respectively, were 5.70 +/- 1.78, 5.75 +/- 1.83, and 5.95 +/- 1.63 before treatment (P >.05); 2.40 +/- 1.18, 3.90 +/- 1.48, and 3.55 +/- 1.60 on the 12th hour of the intervention (P < .05); and 1.25 +/- 0.91, 2.30 +/- 1.34, and 2.15 +/- 1.13 on the 24th hour of the intervention (P < .05). The mean VAS scores decreased within each group (P < .05). However, the mean VAS scores decreased much more significantly in the TENS group (P < .05). Metamizol sodium intake was 1.05 +/- 0.39 g, 2.30 +/- 1.08 g, and 2.90 +/- 1.20 g and pethidine HCL intake was 17 +/- 16.25 mg, 57 +/- 21.54 mg, and 51.50 +/- 18.99 mg, respectively, in the TENS, placebo TENS, and control groups. Metamizol sodium and pethidine HCL intake was least in the TENS group (P < .05). Postoperative complications were observed in 6 (10%) of patients. The most frequent complication was atelectasia., Conclusions: TENS was more effective than placebo TENS or control treatments in decreasing pain and limiting opioid and nonopioid medication intake during the first 24-hour period following MS.

Objective: To evaluate bone metabolism in patients with beta-thalassemia major and to determine the factors associated with the development of osteoporosis., Methods: We studied 25 patients with thalassemia major with a mean age of 18.4 years (range 5-31) and aged and gender matched 24 healthy controls who were attending the outpatient physical medicine and rehabilitation clinic of Akdeniz University Hospital between January 2004 and March 2004 in Turkey. Bone mineral density (BMD) of lumbar spine (L1-L4) and proximal femur were determined using dual x-ray absorptiometry (DXA). Venous blood samples were obtained for determination of blood cell count and markers of bone formation and resorption., Results: The BMD values, both at lumbar and femoral neck levels were significantly lower in patients compared to controls. Serum N-telopeptide level was slightly higher, whereas osteocalcin was slightly lower in patients; however, these values were not statistically significant. Plasma levels of insulin like growth factor-1 (IGF-I) and insulin like growth factor binding protein-3 (IGFBP-3) were significantly lower in patients. Also, serum levels of estradiol and progesterone in females, luteinizing hormone and follicle-stimulating hormone in both gender were significantly lower in patients. Serum levels of free testosterone and total testosterone were lower in patients, but not statistically significant. Patients also had significantly higher serum phosphorus levels, and lower serum calcitonin levels compared to controls., Conclusion: The BMD is decreased in thalassemic patients. Growth retardation, growth hormone / IGF-I / IGFBP-3 axis dysfunction, gonadal dysfunction and hypothalomo-pituitary-gonadal axis dysfunction may be responsible for the development of osteoporosis in the patients with beta-thalassemia major.