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ABSTRACT In the present study, Ornithogalum narbonense, O. montanum, O. wiedemannii, O. sigmoideum and O. lanceolatum species were compared statistically with respect to anatomical characters. Some differences were found in root, stem and leaf anatomy of the species. These differences and similarities were indicated in this study. A big metaxylem was present in all root cross sections, except for O. lanceolatum, which has three metaxylema. 2-3 layered annular type collenchyma were present in all species. Aerenchyma is present in all mesophiles.

Objective: This study aimed to investigate the causes and prevalence of elective surgery cancellations in the operating room, and the clinical outcomes of affected patients., Methods: This prospective, cross-sectional study assessed the prevalence and causes of elective surgery cancellations once patients are in the operating room. A tertiary academic referral center hosted the study between January 2022 and January 2023. The study sample consisted of 7,482 adult patients scheduled for elective surgeries and taken to the operating room. The 7,415 completed procedures were in Group 2, whereas the 67 cancelled surgeries were in Group 1. Patients were divided into two groups on the basis of whether their surgeries were completed or cancelled. Factors such as age, American Society of Anesthesiologists (ASA) status, and surgical department were analyzed. The two groups were compared on the basis of age, ASA status, surgical department, and surgery time (month and day)., Results: Elective surgery cancellations occurred in the operating room at a rate of 0.9%. Group 1 was substantially older than Group 2 (p<0.001). Group 1 had a larger number of ASA III patients (p<0.001). The department with the highest cancellation rate was ophthalmology (2.5%), followed by general surgery (2.1%), urology (1.5%), and ear, nose, and throat (1.4%). It was possible to avoid 59.7% of cancelations., Conclusion: The study revealed a 0.9% prevalence rate of elective surgery cancelations in the operating room. Older age and higher ASA status greatly influenced these cancellations. Optimized surgery scheduling and patient assessment processes may prevent many of these cancellation., Competing Interests: Conflict of Interest: The authors have no relevant financial or non-financial interests to disclose., (©Copyright 2024 by the Turkish Anesthesiology and Reanimation Association / Turkish Journal of Anaesthesiology & Reanimation is published by Galenos Publishing House.)

Methotrexate (MTX) is a drug used in the treatment of various types of cancer and inflammatory diseases, but its clinical use has been restricted due to its toxicity. Apigenin (API) is an effective flavonoid with antioxidant and anti-inflammatory properties. The aim of this study was to determine the protective effect of API against MTX-induced liver and kidney toxicity. Four groups with 12 male mice each were used. The control and API groups were received 0.9% saline (ip) and API (3 mg/kg ip) for 4 days, respectively. The MTX group were given a single dose of MTX (20 mg/kg ip) on the fourth day. The MTX + API group were administered API for 7 days and then MTX on fourth day. Blood, liver and kidney were collected to evaluate tissue injury markers, oxidative stress biomarkers, and histopathological and immunohistochemical assessments. In MTX-treated group, significant increases in aminotransferases activities, creatinine and malondialdehyde (MDA) levels and significant decreases in catalase (CAT), glutathione peroxidase (GSH-Px) and superoxide dismutase1 (SOD1) activities and glutathione (GSH) levels were determined compared to the control group. Furthermore, histopathological changes and significant increases in caspase-3, C-reactive protein (CRP), granulocyte colony-stimulating factor (G-CSF), and inducible nitric oxide synthase (iNOS) expressions were detected in both liver and kidney tissues of MTX-treated mice. Pretreatment with API alleviates liver and kidney toxicity by attenuating oxidative stress and tissue injury markers, histopathological alterations, and apoptosis and inflammation. These results suggest that API has a protective effect against oxidative stress and liver-kidney toxicity induced by MTX.

Purpose: To evaluate the productivity difference between teaching and non-teaching workflow models in an abdominal imaging division in an academic radiology department., Methods and Materials: RVU data were compiled for six faculty members from the abdominal imaging division over a six-month period. Modalities included ultrasound and CT of the abdomen and pelvis. The relative RVU productivity for faculty members by workflow was compared individually and the composite data for the workflow models were compared. The relative RVU productivity for each faculty member was compared individually and in aggregate to study the effect of the workflow models on RVUs using factorial ANOVA. Turnaround times (TAT) were compared for each attending under both models. TAT data were analyzed using paired t-tests with Bonferroni corrections for multiple comparisons., Results: Daily RVU data from 387 instances were analyzed. Daily RVUs for faculty members ranged from 23.5 ± 2.3 (mean ± standard error) to 46.2 ± 2.4 with non-teaching and from 29.8 ± 2.2 to 54.4 ± 2.7 with teaching workflow, respectively. There was a significant main effect of the workflow model on RVU productivity (p < 0.05). A significant increase of 27.8% in RVUs was noted with teaching workflow (42.8 ± 0.9) relative to non-teaching workflow (33.5 ± 1.7; p < 0.05). Teaching workflow resulted in significantly higher view-final and complete-final TATs (593 ± 112 min, mean ± SE and 841 ± 96 min, mean ± SE, respectively) compared to the non-teaching workflow (385 ± 124 min)., Conclusion: Teaching workflow improves abdominal imaging productivity with an increase in report turnaround times.

Objectives: This study aims to investigate the relationship between serum level of nesfatin-1 and fibromyalgia syndrome (FMS) clinical parameters such as pain severity, disease activity, fatigue, emotional state, and sleep quality., Patients and Methods: Forty-six female patients with FMS (median age 40 years; range, 18 to 53 years) and 46 healthy female controls (median age 36 years; range, 19 to 52 years) were included in the study. Severity of pain, disease activity, fatigue, sleep quality, and emotional status were evaluated by visual analog scale, Fibromyalgia Impact Questionnaire, Multidimensional Assessment of Fatigue (MAF), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI), respectively. Serum nesfatin-1 concentrations (pg/mL) were measured by enzyme-linked immunosorbent assay method., Results: There was no significant difference with respect to demographic characteristics between the FMS patients and healthy controls. When clinical parameters were compared, MAF, BDI, BAI, and PSQI scores were significantly higher in FMS patients than controls (p<0.05). Serum nesfatin-1 concentration was significantly lower in patients with FMS (p<0.05). When compared to the FMS patients without anxiety, serum nesfatin-1 concentration was significantly increased in FMS patients with anxiety (p<0.05). Serum nesfatin-1 concentration was positively correlated with BAI scores in patients with FMS (p<0.05)., Conclusion: Low nesfatin-1 serum levels may contribute to pathological changes in FMS. In addition, nesfatin-1 may also be involved in the mediation of anxiety-related responses in FMS., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2020, Turkish League Against Rheumatism.)

Background: Coexisting fibromyalgia (FM) to psoriatic arthritis (PsA) has been identified and it has been associated with more severe symptoms, impaired function, and greater disability. It was aimed to explore the effect of the presence of FM on fatigue in patients with PsA comparing with controls., Methods: Fifty patients with PsA and 34 sex-age matched controls were enrolled. In patients; pain was assessed by Visual Analogue Scale, disease activity by DAS-28, enthesitis by The Leeds Enthesitis Index. Fatigue level of all participants was evaluated by Multidimensional Assessment of Fatigue. In all participants, FM was determined according to 2010 American College of Rheumatology criteria., Results: Seventeen patients with PsA (34%) and 4 controls (11.8%) were diagnosed with FM and all of them were women. There was significant difference between the patients and controls in terms of presence of FM (p < 0.05). Patients' fatigue scores were significantly higher than controls' (p = 0.001). There were significant differences between the PsA patients with and without FM with regard to gender, enthesitis, DAS-28 and pain scores (p < 0.05); fatigue scores (p < 0.001). The significant effect of the presence of FM on fatigue was found by univariate analysis of variance in patients (p < 0.001)., Conclusion: It was observed that FM presence and fatigue were more common in PsA patients than controls and comorbid FM had significant effect on fatigue in these patients. Physicians should be aware of the possibility of concomitant FM in patients with PsA.

Objectives: The aim of this study was to evaluate the relationship of illness perceptions (IPs) with demographic features, severity of pain, functional capacity, disability, depression, and quality of life in patients with chronic low back pain (CLBP)., Patients and Methods: Between January 2015 and July 2015, a total of 114 patients with non-specific CLBP (86 females, 28 males; mean age 47.1±15.2 years; range, 18 to 85 years) were included. Non-specific CLBP was defined as low back pain not attributable to a recognizable, known specific pathology such as infection, tumor, inflammation for ≥12 weeks. The IPs using the revised Illness Perception Questionnaire (IPQ-R), pain severity using the visual analog scale (VAS), functional capacity using the Six-Minute Walk Test (6MWT), disability using the modified Oswestry Disability Index (m-ODI), depression using the Beck Depression Inventory (BDI), and quality of life using the Short Form-36 (SF-36) were assessed., Results: There was a significant, positive correlation between the age, body mass index, duration of disease, pain scores, and IPQ-R- consequences, timeline (acute/chronic), and emotional responses subunits, whereas there was a significant, negative correlation between the IPQ-R-personal and treatment control subunits (p<0.001). The IPQ-R-timeline (acute/chronic), consequences, and emotional response subunits were positively and personal and treatment controls and illness coherence subunits were negatively correlated with the BDI and m-ODI (p<0.001). The IPQ-R-consequences and emotional responses subunits were negatively and timeline (acute/chronic), personal and treatment controls, and illness coherence subunits were positively correlated with the SF-36 subunits (p<0.05)., Conclusion: The IPs were negatively affected by advanced age, high body mass index, longer duration of disease, and increased severity of pain in CLBP patients. Based on these findings, positive IPs may be related with reduced disability and depression, and improved quality of life and functional capacity in this patient population. Developing new strategies for improving the negative IPs of patients with CLBP may be useful., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2019, Turkish Society of Physical Medicine and Rehabilitation.)

Introduction/objective: Ankylosing spondylitis (AS) is usually seen in among younger person of working age and carries a significant economic burden. It was aimed to explore the relation of work instability with fatigue, depression, and anxiety in working AS patients comparing with healthy controls., Method: This case-control study was conducted on working 61 AS patients and 40 sex-age-matched working healthy controls. The data were collected using Visual analogue scale-pain, Bath AS Disease Activity Index, Bath AS Functional Index, Bath AS Metrology Index in patients; and Beck Depression Inventory, Beck Anxiety Inventory, Multidimensional Assessment of Fatigue, AS Work Instability Scale in all participants. Data were analyzed by SPSS, using chi-squared test, Mann-Whitney U test, Kruskal-Wallis test, Spearman correlation analysis, and multivariate linear regression analysis., Results: Depression, fatigue, and work instability scores were significantly higher in patients than controls (p < 0.05). Clinical parameters (except spinal mobility) showed a significant worsening across the levels of work instability in patients (p < 0.05) and work instability scores were positively correlated with all clinical parameters except spinal mobility (p < 0.001). There was a weak correlation between work instability and spinal mobility (p < 0.05). Fatigue (p < 0.001), pain, and functional capacity scores (p < 0.05) were found to be influential variables on work instability scores., Conclusion: The results of this study demonstrated that fatigue and depressive symptoms had negative effect on work instability beside pain, disease activity, and functionality in patients with AS. The recognition and improvement of fatigue and depression may lead to reduced risk of job loss in these patients.

Objectives: This study aims to compare fall history and fear of falling (FOF) in patients with rheumatoid arthritis (RA) and healthy controls and to evaluate associated factors for fall risk and FOF in patients with RA., Materials and Methods: Between March 2016 and July 2016, a total of 120 patients with RA and 60 age- and sex-matched healthy volunteers were included in the study. The presence of FOF (Yes/No), fall history, and the number of falls within the past 12 month were questioned. All participants were assessed with the Falls Efficacy Scale-International (FES-I), 10 Meter Walk Test (10MWT), One-Leg Stand Test (OLST), Berg Balance Scale (BBS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Pain Severity and Patient Global Assessment (PGA) by Visual Analog Scale (VAS), disability by the Health Assessment Questionnaire (HAQ), and disease activity by Disease Activity Score in 28 joints (DAS28) were evaluated in patients with RA., Results: There was no statistically difference between the RA patients and healthy controls in terms of presence of fall history, while the presence of FOF and FES-I scores were significantly higher in the RA patients (p<0.05). In the patient group, the FES-I score was positively correlated with pain VAS, PGA, DAS-28, HAQ, BAI, BDI, and 10MWT and negatively BBS and OLST (p<0.05). The number of falls, HAQ, BBS, and BDI scores were found to be significant independent risk factors affecting variations in the FES-I scores (p<0.001)., Conclusion: Fear of falling seems to be an important problem in patients with RA, and patients without fall history may also have FOF. The most important factors associated with FOF were impaired balance, increased disability and depression, and number of falls in RA patients. Strategies for preventing falls, maintaining balance, improving emotional status and against FOF are of utmost importance in patients with RA., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Objectives: This study aims to evaluate the reliability and validity of the Turkish version of the Short Form of the Social Role Participation Questionnaire (s-SRPQ) in Turkish patients with ankylosing spondylitis., Patients and Methods: The Turkish version of s-SRPQ questionnaire was obtained after a translation and back translation process. The study sample included 100 ankylosing spondylitis patients (59 males, 41 females; mean age 42.0±11.0 years; range 19 to 69 years). To assess the test-retest reliability of the Turkish s-SRPQ, the questionnaire was reapplied 15 days after the first interview (interclass correlation coefficient [ICC]). Cronbach's alpha (a) was used to evaluate the internal consistency. The s-SRPQ was compared with Short Form-36 (SF-36) survey, Ankylosing Spondylitis Quality of Life questionnaire (ASQoL), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Satisfaction With Life Scale (SWLS) for convergent validiy., Results: For s-SRPQ/experienced physical difficulties; the individual item ICC ranged from 0.78 to 1.00 and Cronbach's alpha value ranged from 0.88 to 1.00. For s-SRPQ/satisfaction with role performance; the individual item ICC ranged from 0.93 to 0.98 and Cronbach's alpha value ranged from 0.96 to 0.99. The Turkish version of s-SRPQ/experienced physical difficulties scores correlated with the SWLS and SF-36 sub-parameters negatively; and Ankylosing Spondylitis Disease Activity Index, and BASFI, and ASQoL positively. The SRPQ/satisfaction with role performance scores correlated with the SWLS and SF-36 sub-parameters positively; and BASDAI, and BASFI, and ASQoL negatively., Conclusion: Turkish version of s-SRPQ has good comprehensibility, internal consistency, and validity and is an adequate and useful instrument for the assessment of participation in Turkish patients with ankylosing spondylitis., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Background: Paraplegia or death secondary to upper cervical spine instability and spinal cord compression are known consequences of spondyloepiphyseal dysplasia congenita (SEDC). Stabilization and occasionally decompression of the upper cervical spine are indicated to treat upper cervical instability and stenosis. The purpose of this study was to report the results of upper cervical spine fusion in children with SEDC who had upper cervical instability., Methods: Twenty children (17 females and 3 males) with SEDC who underwent upper cervical spine fusion at a mean age of 72 months were retrospectively analyzed. Three of these children were under the age of 2. Fifteen children had posterior instrumentation and fusion whereas 5 children had posterior in situ fusion without use of any implant. Thirteen of 20 children had iliac crest autograft. Radiographic and clinical results were reported., Results: The average follow-up period was 8 years and 8 months. All children with instrumentation achieved fusion. Three of 5 children who had no instrumentation had nonunion (1 child had a stable nonunion and did not need revision; 1 had a single noninstrumented revision and ended up with a stable nonunion without further intervention; and the third one had a noninstrumented revision and had to have a second, instrumented, revision to achieve fusion). Six children had thoracolumbar scoliosis or kyphoscoliosis which required surgical management.No postoperative neurological deficits were observed. Two of the 3 children with a preoperative neurological deficit showed full recovery and the third one remained unchanged. Pseudarthrosis is the main complication for the noninstrumented group. Distal junctional instability after successful fusion is seen at long-term follow-up (average=6 y) for 13% of patients in instrumented group., Conclusions: Instrumentation and iliac bone grafting results in 100% upper cervical fusion for SEDC children who demonstrated instability before surgery., Level of Evidence: Level IV-therapeutic.

Objectives: This study aims to assess the factor structure of the Turkish Revised Illness Perception Questionnaire (IPQ-R) in patients with rheumatoid arthritis (RA) and the relationship of illness perceptions with disease activity and psychological well-being., Patients and Methods: One hundred and fifty RA patients (8 males, 142 females; mean age 51.1±12.7 years; range 21 to 81 years) were included in the study. Confirmatory factor analysis was used to test the factor structure of the IPQ-R. Pain was assessed by visual analog scale, disease activity by Disease Activity Score 28, depression by Beck Depression Inventory, global life satisfaction by the Satisfaction with Life Scale, and illness perception by the IPQ-R., Results: Three items (items 12, 18, 19) were deleted because of poor factor loadings. The modified 35-item model showed good reliability and discriminant validity. Beck Depression Inventory scores were correlated with identity, consequences, and emotional representations subscales positively (p<0.001); and with illness coherence subscale negatively (p<0.05). There were positive correlations between Satisfaction with Life Scale scores, and treatment control and illness coherence subscales (p<0.05). Satisfaction with Life Scale scores were negatively correlated with identity, emotional representation, and timeline acute/chronic subscales (p<0.05), and consequences subscale (p<0.001). Disease Activity Score 28 was not correlated with IPQ-R domains (p>0.05)., Conclusion: The Turkish IPQ-R appears to be a useful clinical assessment tool to evaluate RA-related illness perceptions. RA healthcare should include psychological intervention to strengthen patients' beliefs about their RA regardless of disease activity., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Objectives: This study aims to evaluate the reliability and validity of the Turkish language version of VITACORA-19 (psoriatic arthritis quality of life questionnaire) in patients with psoriatic arthritis., Patients and Methods: The Turkish version of VITACORA-19 questionnaire was obtained after a translation and back translation process. The study sample included 61 PsA patients (22 males, 39 females; mean age 46.5±12.2 years; range 19 to 71 years). To assess the test-retest reliability of the Turkish VITACORA-19, the questionnaire was reapplied 10 to 15 days after the first interview (interclass correlation coefficient). Cronbach's alpha (a) was used to evaluate the internal consistency. VITACORA-19 was compared with visual analog scale for physician and patient global assessments, the Health Assessment Questionnaire, and Nottingham Health Profile for construct validity. The internal structure of VITACORA-19 was examined by factor analysis., Results: The individual item intraclass correlation coefficient ranged from 0.77 to 0.98 and Cronbach's alpha ranged from 0.77 to 0.98. The Cronbach's alpha value for whole scale was determined as 0.96. The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.90, and Bartlett's test of sphericity had a p<0.001. Turkish VITACORA-19 total scores were correlated negatively with Health Assessment Questionnaire, visual analog scale for pain, and Nottingham Health Profile subgroups, and positively with physician and patient global assessments (p<0.01)., Conclusion: Turkish version of VITACORA-19 questionnaire is a reliable and valid measure for health-related quality of life in Turkish patients with psoriatic arthritis., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Fetal brain magnetic resonance imaging (MRI) is a powerful tool in the diagnosis of symptomatic congenital cytomegalovirus infection, requiring a detailed search for specific features. A combination of anterior temporal lobe abnormalities, white matter lesions, and polymicrogyria is especially predictive. Fetal MRI may provide a unique opportunity to detect anterior temporal cysts and occipital horn septations, as dilation of these areas may decrease later in development. Cortical migration abnormalities, white matter abnormalities, cerebellar dysplasia, and periventricular calcifications are often better depicted on postnatal imaging but can also be detected on fetal MRI. We present the prenatal brain MRI findings seen in congenital cytomegalovirus infection and provide postnatal imaging correlation, highlighting the evolution of findings at different times in prenatal and postnatal developments., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Achondroplasia is the most common form of skeletal dysplasia. Although the radiographic features are well described, MRI features of the knee in achondroplasia have not been reported., Objective: To describe common MRI characteristics of the knee joint in symptomatic children and adolescents with achondroplasia., Materials and Methods: We retrospectively evaluated 10 knee MRI examinations in 8 children and young adults (age range 11-20 years, mean 16.3 years) with achondroplasia. We measured modified Insall-Salvati index, knee flexion angle, anterior cruciate ligament (ACL)-Blumensaat line angle, ACL-tibial angle, posterior cruciate ligament (PCL) angle, intercondylar notch width index, and intercondylar notch depth index. We compared our findings with an age- and gender-matched control group of 20 children (age range 15-18 years; mean 16 years) with normal knee MRIs., Results: All 10 knees in the achondroplasia group had discoid lateral meniscus; 8 meniscal tears were identified. Patella baja was present in half of the study cases. Greater knee flexion and increased ACL-Blumensaat line and PCL angles were seen in all achondroplasia knees. ACL-tibial angle was similar in the study and in the control group. Children with achondroplasia had deeper A-shape femoral notches that extended more anteriorly than those seen in the control group. MRI findings were confirmed in all seven knees with arthroscopic correlation., Conclusion: Discoid lateral meniscus, often with tear, is a consistent feature in knee MRIs of symptomatic children and adolescents with achondroplasia. Other findings include patella baja, knee flexion, deep A-shape intercondylar notch, increased ACL-Blumensaat line angle and taut PCL.

In the present study reveals the morphological, anatomical and ecological characteristic of Orchis spitzelii in Turkey. Plant materials of Orchis spitzefli were collected from 17 different population, between 2010-2013 in Turkey. Orchis spitzelii samples were analyzed for 19 morphological, 20 anatomical and 18 soil characters and habitat properties. As a result, the minimum length of plantwas 200 mm and maximum 500 mm, minimum length of underground part was 25 mm and maximum 94 mm. Number of leaves varied between 3-9. According to habitat definition, Orchis spitzelii grew up to 500 m to 2100 m. Also, Pinus nigra forests and glades were most common habitat of Orchis spitzeii, found generally over calcareous soils.

Aim: The aim of this study was to investigate the relationship between Spondyloarthritis Research Consortium of Canada (SPARCC) enthesitis index and disease activity and health-related quality of life in patients with ankylosing spondylitis (AS)., Methods: Eighty-six AS patients not receiving antitumour necrosis factor (TNF) therapy were included in the study. Spinal pain by visual analogue scale (pain VAS rest and activity), disease activity by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), functional capacity by Bath Ankylosing Spondylitis Functional Index (BASFI), enthesitis severity by SPARCC index, quality of life by Short Form-36 (SF-36), and Bath Ankylosing Spondylitis Metrology Index (BASMI) were assessed in patients. In the laboratory evaluations, the erythrocyte sedimentation rates and serum C-reactive protein levels of the patients were determined., Results: All participants were aged between 18 and 65 years, with a mean age of 36.9 ± 11.13 years. The most frequent region of enthesitis was Achilles tendon insertion into calcaneum (55.8%). Pain VAS rest and activity, BASFI and all parameters of SF-36 were significantly different in AS patients with and without enthesitis. SPARCC index was significantly correlated with pain VAS activity (P < 0.05), pain VAS rest, BASDAI, BASFI and all parameters of SF-36 (P < 0.001). There were no correlations between SPARCC index and BASMI, disease duration and laboratory parameters (P > 0.05)., Conclusion: The clinical assessment of enthesitis in AS is an important outcome measure, and enthesitis indexes such as SPARCC enthesitis index can be valuable tools in the evaluation of disease activity in AS patients not receiving anti-TNF therapy., (© 2013 The Authors International Journal of Rheumatic Diseases © 2013 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.)

Objective: The aim of this trial was to investigate the effect of therapeutic microwave diathermy (MD) on pain, disability, trunk muscle strength, walking performance, mobility, quality of life (QOL), and depression in the patients with chronic low back pain (CLBP)., Methods: A total of 39 patients were included in this study. The patients were randomized into two groups. Group 1 (n=19) received MD treatment and exercises. Group 2 (n=20) was given only exercises. The pain (visual analog scale), disability (Oswestry Disability Questionnaire and pain disability index), walking performance (6 minute walking test, 6MWT), depression and QOL (Short Form 36) of all participants were evaluated. Patients were assessed before treatment (BT), after treatment (AT), and at a 1-month follow-up (F)., Results: The patients with CLBP in each group had significant improvements in pain, disability, muscle strength, endurance, 6MWT, mobility, QOL, and depression AT and F when compared with their initial status. There was no statistically significant difference between the groups regarding the change scores between AT-BT test and F-BT test., Conclusion: Since a 2,450-MHz MD showed no beneficial effects on clinical parameters, exercise program could be preferable for the treatment of patients with CLBP alone.

Background: Acromegaly may lead to balance disturbances and fear of falling due to changes in body composition and co-morbidities., Aim: The aim of this study was to evaluate balance and fear of falling in acromegalic patients and their relation with disease characteristics., Materials and Methods: Forty-eight acromegalic patients and 41 age- and gender-matched controls were enrolled in the study. The median ages of the patients and controls were 48 (25-75) and 50 (25-67) yr, respectively. Berg Balance Scale (BBS) and one-leg stance test (OLST) were used to compare dynamic and static balance respectively, 50 meters walking test was used to compare functional capacity and falls efficacy scale-international (FES-I) was used to compare fear of falling between the groups., Results: Balance tests (BBS and 50 meter walking test) and fear of falling (FES-I) were significantly disturbed in patients compared with controls. There was no significant difference in OLST. BBS and OLST were negatively and FES-I was positively correlated with age. FES-I was negatively correlated with BBS and OLST was positively correlated with 50 meters walking test. Only OLST was negatively correlated with disease duration. Logistic regression analysis revealed that balance was not affected by the presence of co-morbidities, postoperative vision loss and disease control., Conclusions: This is the first study showing that balance is disturbed in acromegalic patients. This disturbance is not related to disease control and co-morbidities but somewhat to disease duration.

The aim of this clinical trial was to evaluate the effectiveness of therapeutic MD on pain, functional capacity, muscle strength, quality of life, and depression in patients with subacromial impingement syndrome (SIS). A total of 40 inpatient subjects with definite SIS were included in this study. These patients were sequentially randomized into 2 groups. Group 1 (n = 20) received therapeutic MD. Group 2 (n = 20) was served as control group and received sham MD. Superficial heat and exercise program were given to both groups. Both of the programs were performed 5 times weekly for 3 weeks. Patients were assessed before treatment (BT), after treatment (AT), and at a 1-month follow-up (F). Outcome measures included visual analogue scale, goniometry, Shoulder Pain and Disability Index, Shoulder Disability Questionnaire, shoulder isokinetic muscle testing, handgrip strength, Short Form 36, and Beck Depression Index. The patients with SIS in each group had significant improvements in pain, shoulder ROM, disability, shoulder muscles and grip strength, quality of life, and depression AT and F when compared with their initial status (P < 0.05). There was no statistically significant difference between the groups according to all the parameters regarding the change scores between AT-BT test and F-BT test (P > 0.05). A 2,450-MHz MD regimen showed no beneficial effects in patients with SIS, so the superficial heat and exercise program, as it is efficient, may be preferable for the treatment of SIS, alone.

The FES-I is a questionnaire which was developed to assess fear of falling. The aim of this study was to evaluate validity and reliability of a Turkish language version of the FES-I in Turkish older people. The study sample included 70 volunteers with an age range of 65-81. To assess the test-retest reliability of the Turkish FES-I, questionnaire was applied again 10-15 days after the first interview (interclass correlation: ICC). FES-I was compared with The Modified Barthel Index (MBI), the timed up and go test (TUG), and The Berg Balance Scale (BBS) for construct validity. Cronbach's alpha (α) was used to evaluate the internal consistency. The internal structure of the FES-I was examined by factor analysis. ROC plots were used to define cut-point for the FES-I scales. Cronbach's α of the Turkish FES-I was 0.94 and the individual item ICC ranged from 0.97 to 0.99. The Turkish FES-I total scores were correlated with TUG positively, and MBI, and BBS negatively. The cut-off score to differentiate between persons with fear of falling and persons without fear of falling was 24 points. It was found that the Turkish version of the FES-I was a reliable and valid measure of fear of falling in Turkish older people., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Aim: The aim of this trial was to evaluate the short-term effectiveness of ultrasound (US) therapy on pain, physical function, ambulation activity, disability and psychological status in patients with knee OA., Methods: Forty-two inpatients with bilateral knee OA were randomized by an independent researcher not involved in the data assessment, to receive either therapeutic continuous US (group 1) or sham US (group 2). A 1-MHz US head was used, set to an intensity of 1 W/cm(2) for 10 min. All patients received 20 min of hot packs, 10 min of interferential current, and 15 min of quadriceps isometric exercise of both knees. Patients in each group received treatments five times weekly for 3 weeks. Patients were evaluated at baseline and at the end of the treatment sessions. Outcome measures included visual analogue scale (VAS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), 50-m walking speed, Lequesne index, Hospital Anxiety and Depression Scale (HADS)., Results: The patients with knee OA had significant improvements in pain, stiffness, functional activity, walking time, disability, depression and anxiety scores with therapeutic US and sham US (P < 0.05). The improvement in pain VAS scores, WOMAC scores, Lequesne index and HADS scores were not significantly different in patients treated with US and sham US (P > 0.05). No side-effects were reported during or after the US treatment periods., Conclusion: US therapy is safe but use of US in addition to conventional physical therapy programs seems to have no further significant effect in people with knee OA., (© 2012 The Authors International Journal of Rheumatic Diseases © 2012 Asia Pacific League of Associations for Rheumatology and Blackwell Publishing Asia Pty Ltd.)

Objective: To evaluate the impact of functional disability of Turkish children with spina bifida (SB) on parents' psychological status and family functioning., Methods: Fifty-four children with SB and parents were included. The Functional Measure for Children (WeeFIM), Beck Depression Inventory (BDI), and Family Assessment Device (FAD) were used., Results: Mothers' BDI scores were significantly higher than fathers' (p < 0.001). No significant effects of the knowledge of having children with SB before birth and the number of children in families on BDI scores and FAD sub-scores were found (p > 0.05). According to multiple regression analysis; significant correlations with fathers' BDI were problem-solving (p = 0.012) and general functioning (p = 0.037) and with mothers' BDI was roles (p = 0.018). Only childrens age was found to be an influential variable on WeeFIM scores (p < 0.001)., Conclusion: Spina bifida healthcare should include psychological support to parents of these children and this support should be independent from disability level of children.

Objectives: The aim of this study was to compare the sleep quality in patients with rheumatoid arthritis (RA) and fibromyalgia syndrome (FMS); and to evaluate the relationship between sleep quality and pain, fatigue, depression, and disease activity in patients with RA and FMS., Methods: Forty RA, 40 FMS and 40 healthy controls were enrolled in the study. Disease activity and disease duration were reported in patients. Pain by visual analogue scale (VAS), fatigue by Multidimensional Assesment of Fatigue (MAF), depression by Beck Depression Index (BDI), and sleep quality by Pittsburgh Sleep Quality Index (PSQI) were gathered in all participants., Results: All participants were aged between 20 and 65 years, with a mean age of 42.97±10.75 years. There was no significant difference with respect to demographic characteristics among the three study groups. Patients reported more depression than controls, but BDI scores were similar in FMS and RA patients. VAS pain scores and MAF scores were significantly different in the three groups (p<0.001). FMS and RA patients had poor sleep quality (p<0.001). FMS patients had daytime dysfunction due to sleep disorder and had worse habitual sleep efficiency than RA patients (p<0.05). In patients, positive correlations were found between PSQI and clinic assessment variables except disease duration., Conclusions: FMS and RA may have poor sleep quality when compared to subjects without rheumatologic disorders. The quality of sleep can be impaired by pain, fatigue, depression, and disease activity in such patients.

An aberrant subarcuate artery and its related canal are rare. The presence of this variation has a surgical significance, that is, risk of hemorrhage, if accidentally nicked. It is therefore important to be aware of this entity, and its relative anatomy, to avoid any untoward complication. We present a case of a 29-year-old man who presented with hearing loss after trauma. High-resolution computed tomographic scan of the temporal bone demonstrated an enlarged subarcuate canal.

Objective: The objective of our study was to evaluate the diagnostic utility of conventional radiography for diagnosing bisphosphonate-related atypical subtrochanteric femoral fractures., Materials and Methods: Retrospective interpretation of 38 radiographs of complete subtrochanteric and diaphyseal femoral fractures in two patient groups-one group being treated with bisphosphonates (19 fractures in 17 patients) and a second group not being treated with bisphosphonates (19 fractures in 19 patients)-was performed by three radiologists. The readers assessed four imaging criteria: focal lateral cortical thickening, transverse fracture, medial femoral spike, and fracture comminution. The odds ratios and the sensitivity, specificity, and accuracy of each imaging criterion as a predictor of bisphosphonate-related fractures were calculated. Similarly, the interobserver agreement and the sensitivity, specificity, and accuracy of diagnosing bisphosphonate-related fractures (i.e., atypical femoral fractures) were determined for the three readers., Results: Among the candidate predictors of bisphosphonate-related fractures, focal lateral cortical thickening and transverse fracture had the highest odds ratios (76.4 and 10.1, respectively). Medial spike and comminution had odd ratios of 3.8 and 0.63, respectively. Focal lateral cortical thickening and transverse fracture were also the most accurate factors for detecting bisphosphonate-related fractures for all readers. The sensitivity, specificity, and overall accuracy for diagnosing bisphosphonate-related fractures were 94.7%, 100%, and 97.4% for reader 1; 94.7%, 68.4%, and 81.6% for reader 2; and 89.5%, 89.5%, and 89.5% for reader 3, respectively. The interobserver agreement was substantial (κ > 0.61)., Conclusion: Radiographs are reliable for distinguishing between complete femoral fractures related to bisphosphonate use and those not related to bisphosphonate use. Focal lateral cortical thickening and transverse fracture are the most dependable signs, showing high odds ratios and the highest accuracy for diagnosing these fractures.

We proposed to assess serum antioxidant vitamins and magnesium (Mg) levels in patients with fibromyalgia (FM) in comparison to healthy controls. Additionally, the association between the serum antioxidant vitamins, magnesium levels, and clinical parameters in FM patients was also investigated. Forty female patients, aged between 30 and 50 years, were diagnosed with FM according to ACR-1990 criteria, and 40 healthy controls were included in the present study. Socio-demographic characteristics of participants, accompanying symptoms, and number of tender points (TP) of the patients were recorded. The intensity of pain was measured using the visual analogue scale (VAS). The functional status and depression levels were evaluated with Fibromyalgia Impact Questionnaire (FIQ) and Beck Depression Inventory (BDI), respectively. Serum vitamins A, C, and E and Mg levels were measured. There were no significant differences in the levels of vitamins A, C, and E and Mg between control subjects and patients with fibromyalgia (p > 0.05). In addition, no statistically significant correlations were found between mean levels of serum vitamins A, C, and E, and Mg and number of TP, scores of VAS, FIQ, and BDI in patients with FM (p > 0.05). According to the results of this study, it was asserted that other complex mechanism may play an important role in the pathophysiology of FM without plasma antioxidant vitamins and Mg levels.

Background: Knee osteoarthritis (OA) is a painful condition causing disability and muscle weakness. Shortwave diathermy (SWD) is one of several physical therapy modalities and used predominantly as a pain reduction modality in the clinical practice. However, the efficacy of SWD in knee OA is still inconclusive., Aim: The aim of this study was to determine if SWD increase the effectiveness of isokinetic exercise on pain, function, muscle strength, quality of life and depression in patients with OA., Design: This was a randomised, controlled clinical trial., Setting: Inpatient Physiotherapy Department., Population: Forty women aged between 42 and 74 years, with a diagnosis of bilateral primary knee OA., Methods: Patients were sequentially randomized into two groups. Group 1 (N.=20) received SWD and isokinetic muscular strengthening exercises. Group 2 (N.=20) served as control group and they received isokinetic exercises only. Both of the programs were performed three days a week, for a duration of four weeks, and a total of 12 sessions. Patients were assessed before treatment (BT), after treatment (AT), and at a three-month follow-up (F). Outcome measures included visual analogue scale, Western Ontario and McMaster University Osteoarthritis Index, six minute walking distance, isokinetic muscle testing, Short Form 36 and Beck depression index., Results: The patients with OA in each group had significant improvements in pain, disability, depression, walking distance, muscle strength, and quality of life AT and F when compared with their initial status (P<0.05). There was no statistically significant difference between the groups according to all the parameters regarding the change scores between AT-BT test and F-BT test (P>0.05) except some isokinetic peak torque measurements (F-BT scores of extension right 60°, 120° and flexion right 60°)., Conclusion: Use of SWD in addition to isokinetic exercise program seems to have no further significant effect in terms of pain, disability, walking distance, muscle strength, quality of life and depression in patients with knee OA., Clinical Rehabilitation Impact: Considering the time and cost of combination therapy is now, the isokinetic exercise program, as it is efficient, may be preferable for the treatment of knee OA, alone.

The aim of this clinical trial was to evaluate the effects of electrical stimulation (ES) program on trunk muscle strength, functional performance, quality of life (QOL) in the patients with chronic low back pain (CLBP). A total of 41 patients with definite CLBP were included in this study. These patients were randomized into two groups. Group 1 (n = 21) was given an ES program and exercises. Group 2 (n = 20) was accepted as the control group and given only exercises. Both the programs were performed 3 days a week, for 8 weeks in the out-patient department. The patients were evaluated according to pain, disability, functional performance, endurance, quality of life, depression. The muscle strengths were measured with a hand-held dynamometer. There were significant improvements for all the parameters in two groups after the treatment. Except depression and social function, the improvements for all the parameters were better in the ES group than in the control group. We observed that ES program was very effective in improving QOL, functional performance and isometric strength. In conclusion, we can say that ES therapy provides comfortable life functions by improving muscle strength, functional performance and QOL.

High mortality rates resulting from the surgical treatment of Type B aortic dissections have played an important role in seeking newer alternative therapy modalities for the treatment of the pathology. Especially since the early 1990s, endovascular grafting has become a popular option in the treatment of aortic diseases and with the increasing experience and advances in technology, it has, in recent years, become an alternative approach for the treatment of aortic dissections. In this report, we present the treatment of a 56-year-old male patient with a history of a coronary artery bypass grafting who presented with chronic type B aortic dissection. Endovascular stent graft implantation was performed with a hybrid therapy type of preliminary right subclavian artery to left subclavian artery bypass, followed by endovascular stent graft implantation to the dilated aneurismal segment of the descending aorta, for the treatment of chronic type B aortic dissection. The procedure and the postoperative course were uneventful; moreover, they were very comfortable for the patient undergoing an investigation of the descending aorta, when compared with the conventional surgical treatment modalities.

Cardiac myxomas are the most common neoplasms of the heart. They can be located in any chamber of the heart but frequently in the left atrium. In this report we present a patient who had been treated for a right ventricular myxoma originating from the interventricular septum and leading to right ventricular outflow tract obstruction.

The aim of this study was to investigate the endothelial dysfunction (ED) and carotid intima-media thickness (IMT) in patients with glycogen storage disease (GSD) types Ia and III. In 22 patients with GSD (13, type Ia; 9, type III) and 18 healthy subjects, endothelial functions of the brachial artery and carotid IMT were evaluated by high-resolution ultrasound. Endothelial-dependent dilatation (EDD) was assessed by establishing reactive hyperemia. EDD and carotid IMTs were compared between the three groups. Mean cholesterol level was slightly higher in GSD type III patients but the difference was not significant. Triglyceride levels and cholesterol to high density lipoprotein (HDL) ratio were significantly higher in GSD type Ia patients. EDD was significantly impaired in GSD type Ia (13% +/- 8%, P = .001) and type III (15% +/- 6%, P = .005) patients when compared with the healthy subjects (22% +/- 4%). The carotid IMT was significantly higher in both GSD type Ia (0.23 +/- 0.03 mm, P =.005) and type III (0.26 +/- 0.05 mm, P = .001) patients when compared with the healthy subjects (0.20 +/- 0.02 mm). Both GSD type Ia and type III patients show significant ED and increased IMT, which are predictors of atherosclerosis.

Endothelial dysfunction is an early key event in the development of atherosclerotic cardiovascular disease observed in chronic renal failure patients. The role of renal transplantation (RTx) on endothelial dysfunction is still unclear. The aim of this study was to evaluate the endothelial function of chronic renal failure patients before RTx (while they were on hemodialysis, HD), and after RTx (at the 6th and 12th months) by a noninvasive method, brachial arterial ultrasound. A total of 22 (17 male, mean age: 33.9 +/- 11.6 years) RTx recipients were enrolled in the study. Endothelium-dependent vasodilation (EDD) was assessed by establishing reactive hyperemia. EDD prior to transplantation was significantly lower when compared with EDD measured at the 6th and 12th months after RTx (EDD pretransplantation: 6 +/- 3.7%, EDD at the 6th month of RTx: 8.3 +/- 2.3% and EDD at the 12th month of RTx: 12.1 +/- 3.6%, P < 0.001). When the EDD values measured at the 6th and 12th months of RTx were compared, measurements of the 12th month were found significantly higher than those of the 6th month (P < 0.001). Our results also showed that RTx has provided improvement in endothelial function by eliminating the uremic environment although not in the early post-RTx period.

Objective: To report a case of acute myopathy after concomitant use of colchicine and pravastatin., Case Summary: A 65-year-old woman was admitted to the hospital with an acute episode of gout. She had been taking pravastatin 20 mg once daily for 6 years. On admission, blood urea nitrogen and serum creatinine levels were 48 mg/dL and 1.3 mg/dL, respectively. Colchicine 1.5 mg/day was added to the treatment regimen, but 20 days after the initiation of colchicine therapy, symmetrical proximal muscle weakness developed in the woman's legs. Physical examination, laboratory findings, and electromyelogram findings suggested myopathy. The Naranjo probability scale indicated a probable relationship between myopathy and combined therapy. Seven days after discontinuation of colchicine and pravastatin, the patient's weakness improved and enzyme levels returned to normal. Colchicine was restarted at 1.0 mg/day 5 days later; no myopathy occurred., Discussion: Hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) and colchicine are known to cause myopathy. Most of the statins and colchicine are biotransformed in the liver primarily by the CYP3A4 system, which may increase the risk of myopathy when concurrent therapy is used. However, pravastatin is not primarily metabolized by cytochrome P450 isoenzymes. The cause of myopathy in our patient may be related to the interaction of colchicine and pravastatin via P-glycoprotein. In addition, the presence of mild renal dysfunction could have contributed to the development of myopathy., Conclusions: We suggest that clinicians be aware that neuromuscular toxicity can occur in patients with mild renal dysfunction with combined use of colchicine and pravastatin.