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Objectives Our aim in this study was to examine the effects of different anti-inflammatory treatment strategies on the process of atherosclerosis, which is an important cause of mortality in ankylosing spondylitis (AS) patients, by examining the possible effect of treatments on inflammation, lipid profile and oxidative stress parameters in patients with AS. Methods In this study, 32 healthy volunteers served as the control group in addition to a total of 76 AS patients who were divided into two groups according to whether they were receiving anti-TNF medications or not. We assessed the levels of inflammation, oxidative stress, lipid profile parameters, and oxidized low-density lipoprotein (oxLDL). The atherogenic index of plasma (AIP), non-HDL cholesterol levels, BASDAI, and BASFI scores were also calculated. Results AS patient groups and the control group had similar lipid profile parameters, thiol-disulfide homeostasis metrics, non-HDL cholesterol, oxLDL, and AIP levels (p>0.05). In contrast to AS patients receiving non-anti-TNF treatment, the BASDAI and BASFI scores, ESR, and CRP levels were lower in AS patients receiving anti-TNF treatment (p Conclusions AS patients face increased oxidative stress that does not correlate with inflammatory status and disease activation level. Anti-TNF alpha treatment may reduce some risk factors of atherosclerotic CVD in AS patients.

Objective:This study aimed to evaluate sleep disturbance in patients with ankylosing spondylitis (AS) and to analyse the relationship between disease activity, anxiety/depression and pain level.Materials and Methods:Disease activity was assessed using the Bath ankylosing spondylitis disease activity index (BASDAI), sleep disturbance was evaluated by the Epworth sleepiness scale (ESS), pain level was evaluated by the visual analogue scale and emotional state was evaluated by the Beck depression inventory (BDI), state-trait anxiety inventory (STAI) I and STAI II. Data were examined using independent samples t-tests and Pearson’s correlation analysis.Results:Daytime sleepiness, depressive mood and anxiety levels were higher in patients with AS than in healthy controls. The ESS score correlated with BASDAI, BDI, STAI I and STAI II. Patients with AS had a considerably impaired sleep quality compared with the healthy controls, and a strong correlation was found between sleep and mood. A positive correlation was also noted between disease activity/pain severity and sleep quality.Conclusion:Measuring sleep quality and mood is important for the comprehensive evaluation of the health status of patients with AS, which could provide valuable evidence for improving the management of disease and treatment decisions.

The aim of this study is to investigate the effectiveness of high intensity laser therapy on pain, functionality, flexion range of motion (FROM), and ultrasonographic cartilage measurement in patients with knee osteoarthritis.This study was designed as a double-blind randomized placebo-controlled study. Forty patients diagnosed with knee osteoarthritis according to the American College of Rheumatology criteria were included in the study. After obtaining written informed consent, patients were randomized into high intensity laser therapy (HILT) + exercise therapy (ET), and placebo laser (PL) + ET groups. Each patient was treated five sessions per week for 2 weeks. The outcomes measured were pain level and functional disability using the visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), respectively. The femoral cartilage thickness measurement was made ultrasonographically, and FROM was measured with goniometry.Statistically significant improvements were detected in VAS, WOMAC scores, femoral cartilage thickness, and FROM at the end of the treatment (in week 2) compared to the pre-treatment period in both groups (p0.05). There were significant decreases in the VAS and WOMAC scores of both groups in the 6th week compared to the pre-treatment period, and the results of the FROM and femur cartilage thickness measurements were increased at statistically significant levels (p0.05). The VAS and WOMAC scores were significantly lower in the 6th week in HILT + ET group compared to the PL + ET group (p0.05). Similarly, statistically significant increases were detected in the FROM and femur cartilage thickness measurements in HILT + ET group (p0.05).HILT + ET combination was more effective in KOA than the PL + ET combination. Key Points • HILT is an effective modality on pain, functional status and FROM in patients with KOA. • HILT is a modality that increases femoral cartilage thickness in patients with KOA.

Objective:This study investigates the role of ATG16L1 rs2241880, ATG10 rs1864183 and ATG5 rs2245214 gene polymorphisms, which are involved in autophagosome formation, in the susceptibility to postmenopausal osteoporosis (PMO) disease.Materials and Methods:Hundred PMO patients and 100 healthy controls without PMO were included into the study. The distribution of the genotypes of ATG16L1 rs2241880, ATG10 rs1864183 and ATG5 rs2245214 polymorphisms in these subjects were analyzed using the TaqMan 5´-exonuclease allelic discrimination assay.Results:The T allele was detected more frequent among patients with osteoporosis (53%) of the ATG10 rs1864183 polymorphism. C allele in ATG16L1 rs2241880 polymorphism in the group of patients with osteoporosis was observed more frequent (56.5%). Besides, the G allele of the ATG5 rs2245214 polymorphism was identified more common in PMO (34%) than in control group. However, no significant difference were detected in genotype and allele frequencies in terms of these polymorphisms between the patient and the control groups (p>0.05).Conclusion:In summary, the results of our study do not support the hypothesis that ATG16L1 rs2241880, ATG10 rs1864183 and ATG5 rs2245214 polymorphisms influence the predisposition for osteoporosis in postmenopausal women.

Objectives The aim of this study was to investigate the frequency of alexithymia and attention deficit and to evaluate their relationship with the severity of disease in patients with fibromyalgia syndrome (FMS). Patients and methods A total of 101 patients (6 males, 95 females; mean age 45.0 years; range, 33 to 56 years) who were admitted to Gaziantep University, Medical Faculty, Physical Medicine and Rehabilitation Department between January 2013 and December 2013 and were diagnosed with FMS and 40 healthy volunteers (4 males, 36 females; mean age 41.5 years; range, 31 to 51 years) were enrolled in this study. The Fibromyalgia Impact Questionnaire (FIQ), Hamilton Depression Scale (HAM-D), Toronto Alexithymia Scale-26 (TAS-26), and Jasper-Goldberg Attention Deficit Test (ADT) were applied. Results The rate of alexithymia and possible alexithymia was 56.4% and 20.8% in the patients with FMS and 2.5% and 5% in the control group, respectively. The mean TAS-26 score was 60.1±11.7 in the patients with FMS. According to the HAM-D, depressive symptoms were seen in 72.0% and 2.5% of the patients with FMS and healthy controls, respectively. Conclusion Our study results confirm the presence of psychiatric comorbidities in patients with FMS and clearly suggest that depression, alexithymia, and attention deficit are high and mutually correlated in FMS patients. Therefore, all patients should be meticulously evaluated for these conditions at the treatment stage.

Objective: In this paper, we aimed to evaluate the effect of repetitive Transcranial Magnetic Stimulation (rTMS) on central pain in patients with stroke. Material and Methods: Ten patients who had a stroke history were included in this preliminary study. Patients with middle cerebral artery lesion, first-time stroke, subacute or chronic lesion and no other neurological involvement were included. Patients were examined before and after the first month of treatment with repetitive Transcranial Magnetic Stimulation (rTMS). Visual Analog Scale (VAS) was used for pain scale measurement; Leeds Assessment of Neuropathic Symptoms and Signs Scale (LANSS) and Douleur Neuropathique en 4 Questions (DN4) were used for neuropathic pain level and Beck Depression Inventory (BDI) for depressive mood. All patients received the current treatments and appropriate neurorehabilitation as recommended for the treatment of ischemic stroke Results: This prospective study included a total of 10 post-stroke patients (mean age 58.2 ± 16.1 years; range 29 to 75, 8 male; 2 female) with neuropathic pain. The mean values of VAS, LANSS, DN4 and BDI scales were significantly decreased after rTMS treatment in all patients. Conclusion: We discussed the preliminary results of the efficacy and safety of rTMS in the treatment of uncontrolled neuropathic pain. We consider that, rTMS may have significant effect on relief of chronic pain. These clinical parameters can be utilized for the further study of rTMS application in pain control.

BACKGROUND The purpose of this study was to investigate the frequency of using lower extremity orthosis prescribed for patients with cerebral palsy (CP) and to determine the factors associated with orthosis use. STUDY DESIGN The study had a retrospective and descriptive design. METHODS One hundred and twenty-nine patients with CP who were prescribed orthoses were included in this study. The sociodemographic data and orthosis use status of patients were questioned with telephone calls. Motor functions were evaluated with Gross Motor Function Classification System (GMFCS). Spasticity was evaluated with the modified Ashworth scale, and range of motion was evaluated by goniometry. The study had a retrospective and descriptive design and included 129 patients with CP (53 females and 76 males) who were prescribed orthosis. The sociodemographic data and orthosis use status of patients were questioned with telephone calls. Motor functions were evaluated with Gross Motor Function Classification System (GMFCS). Spasticity was evaluated with the modified Ashworth scale, and range of motion was evaluated by goniometry. RESULTS A total of 53 patients who were included in the study were female, and 76 were male. The most commonly used orthosis was Ankle-Foot Orthosis. The number of patients who used orthosis every day was 45 (34.8%). The most common reason for not using orthosis was difficulty in wearing it. The mean age was significantly lower in the group that used orthosis regularly (P < 0.05). Spasticity and range of motion limitations were low in the group that used orthosis regularly at significant levels (P < 0.05). A significant relation was detected in logistic regression analysis between age and orthosis use (P < 0.05). CONCLUSION Regular orthosis use is at quite low levels in patients with CP. The decision for prescribing orthosis should be made with a rehabilitation team, with the patient included before orthosis is prescribed. Problems related to orthosis use should be addressed at regular intervals after prescribing orthosis.

Objectives: The objective of the present study was to investigate the effect of the Pulmonary Rehabilitation Program on work productivity, disease activity, functional status, quality of life, Respiratory Function Tests (RFTs), physical capacity,and depression in Ankylosing Spondylitis (AS) patients. Method: Twenty-five patients diagnosed with AS were included in the study. The disease severity was evaluated with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), functional status was evaluated with Bath Ankylosing Spondylitis Functional Index (BASFI), and quality of life was evaluated with AS-Related Quality of Life scale (ASQOL). Physical capacity was evaluated with the 6-Minute Walking Test (6MWT), depression level was evaluated with Beck Depression Scale (BDS),and work productivity was evaluated with Spondyloartropathy Work Productivity and Activity Impairment (WPAI-SpA) Survey. RFT was evaluated with spirometry measurement. The patients were included in the Pulmonary Rehabilitation Program for 8 weeks. Results: A total of 30% of the patients who were included in the study were unemployed; 35% of them were on and below hunger limit; 25% were on and below poverty line; and 40% were on normal income line. No significant changes were detected in the RFTs after the exercise program in AS patients (p > 0.05), but significantly improvements were detected in the BASDAI, BASFI, WPAI, 6MWT, ASQOL and BDS scales (p

OBJECTIVE The objective of the present study was to investigate the effect of the Pulmonary Rehabilitation Programme on work productivity, disease activity, functional status, quality of life, respiratory function tests (RFTs), physical capacity and depression in ankylosing spondylitis (AS) patients. METHOD Twenty-five patients diagnosed with AS were included in this study. The disease severity was evaluated with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), functional status was evaluated with Bath Ankylosing Spondylitis Functional Index (BASFI), quality of life was evaluated with AS-Related Quality of Life Scale (ASQOL), physical capacity was evaluated with the 6-min walking test (6MWT), depression level was evaluated with Beck Depression Scale (BDS) and work productivity was evaluated with Spondyloartropathy Work Productivity and Activity Impairment (WPAI-SpA) Survey. Finally, RFT was evaluated with spirometry measurement. The patients were included in the Pulmonary Rehabilitation Programme for 8 weeks. RESULTS A total of 30% of the patients who were included in this study were unemployed, 35% of them were on and below the hunger limit, 25% were on and below the poverty line, and 40% were on the normal income line. No significant changes were detected in the RFTs after the exercise programme in AS patients (P > .05), but significant improvements were detected in the BASDAI, BASFI, WPAI, 6MWT, ASQOL and BDS (P

Objective: A residential environment refers to the physical and social characteristics in a neighbourhood. The physical characteristics include interior housing qualities, exterior neighbourhood characteristics, and the accessibility of essential facilities and services outside the neighbourhood. Older adults especially may be vulnerable to the negative impacts of the residential environment. The aim of this study is to elucidate the problems ageing people face in their neighbourhoods, buildings and public areas. Methods: The study group consisted of a total of 1,001 people over the age of 65 who were admitted to physical medicine and rehabilitation clinics in Turkey and consented to participate. A questionnaire covering demographic, social and environmental information was used. Results: Of the study group, 58.6% was living in an apartment building, but only 23.6% of these buildings had an elevator, and the stairs were inconvenient in 46.7% of the buildings. Only 49% of the elderly people went for a walk regularly. The most frequent complaint about the hospitals, community health centres and other public areas was the inappropriate restroom conditions. Eighty-six percent of the study group were not members of an organization, a foundation or a group, and 73.6% did not have personal hobbies. Conclusions: The layouts of buildings and surroundings are inappropriate for older people, and the opportunities for them to participate in social activities are limited. Health and social programmes and governmental and local policies for older people are needed, and public awareness about this issue should be raised.

INTRODUCTION: Fibromyalgia syndrome (FMS) is a clinical condition characterised by chronic generalised body pain, fatigue and presence of tender points. In this study, we hypothesized that FMS could be a type of neuropathic pain and investigated the relationship between neuropathic pain and sleep disturbance and depression. We also investigated the association between these clinical conditions and disease severity METHODS: Seventy-six patients who had FMS diagnosis according to 2010 ACR criteria were included in the study. Patients were evaluated by Fibromyalgia Impact Questionnaire (FIQ), Hamilton Depression Rating Scale (HAM-D), Pittsburgh Sleep Quality Index (PSQI), Douleur Neuropathique 4 Questions (DN4) and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS). RESULTS: Patients had neuropathic pain in 92.1% of patients with LANSS and 82.9% of patients with DN4. According to the Pittsburg Sleep Quality Scale, 90.8% of patients had poor sleep quality. According to HAM-D, 82.9% of the patients had depression. The mean FIQ values of the patients were calculated as 63.16±10.73. There was a positive correlation between DN4 values and FIQ, PSQI, HAM-D and LANSS. There was a positive correlation between LANSS values and FIQ and PSQI values. CONCLUSION: In this study we found the frequency of neuropathic pain high in FMS. We also found a positive association between neuropathic pain scales and depression, sleep disturbance, and fibromyalgia impact score. Pain, functionality and psychosocial characteristics should be assessed extensively to understand fibromyalgia completely. Abnormal pain process and secondary clinical conditions should be considered together.

Sen, Ekin Ilke/0000-0002-6489-3368; karahan, ali yavuz/0000-0001-8142-913X; Akaltun, Mazlum Serdar/0000-0002-9666-9483, WOS: 000496659300007, Purpose Dysphagia is known to be a disorder of the swallowing function, and is a growing health problem in aging populations. Swallowing screening tests have mostly been studied in comorbidities such as stroke associated with old age. There is no simple, quick and easy screening test to best determine the risk of oropharyngeal dysphagia in geriatric guidelines. We aimed to evaluate whether the Gugging Swallowing Screen (GUSS) test is an effective method for evaluating swallowing difficulty in healthy older people. Methods This cross-sectional and multicenter study was conducted at 13 hospitals between September 2017 and February 2019. the study included 1163 participants aged >= 65 years and who had no secondary dysphagia. Reliability was evaluated for data quality, scaling assumptions, acceptability, reliability, and validity as well as cutoff points, specificity and sensitivity. Results the age distribution of 773 (66.5%) patients was between 65 and 74 years and 347 (29.8%) of them were male and 767 (66%) patients were female. the average total GUSS score was 18.57 +/- 1.41. the Cronbach's alpha was 0.968. There was a moderate statistically significant negative correlation between the total GUSS and 10-item Eating Assessment Tool scores as well as between the total GUSS score and quality of life. the cutoff point of the total GUSS score was 18.50, sensitivity was 95.5% and specificity was 94.4%. Conclusions the GUSS test is a valid and reliable test to identify possible oropharyngeal dysphagia risk in healthy older people who had no secondary dysphagia. It is suitable as a screen test for clinical practice. Key summary pointsAim We aimed to evaluate whether the Gugging Swallowing Screen (GUSS) test is an effective method for evaluating swallowing difficulty in healthy older people. Findings Total GUSS score sensitivity was 95.5% and its specificity was 94.4%. Message the GUSS test is a valid and reliable test to identify possible oropharyngeal dysphagia risk in healthy older person who had no secondary dysphagia. It is suitable as a screen test for clinical practice.

Akaltun, Mazlum Serdar/0000-0002-9666-9483; Sen, Ekin Ilke/0000-0002-6489-3368; karahan, ali yavuz/0000-0001-8142-913X WOS: 000476771900010 Key summary pointsAimOur aim was to investigate which swallowing difficulty of food consistency in older people who did not have any disease that might affect swallowing functions, and which symptoms were most likely related to oropharyngeal dysphagia (OD) risk.FindingsWe have found that the eating/drinking difficulty of thick liquids was the highest predictive value with respect to OD risk and the eating difficulty of mixed content food had the highest diagnostic ratio.MessageThe present study reports that even in older person who do not go to the hospital with the complaints of swallowing difficulty, the difficulty of swallowing thick liquids and especially the mixed content food should be questioned. AbstractPurposeThe present study aimed to investigate which swallowing difficulty of food consistency in participants over 65years of age who did not have any disease that might affect swallowing functions, and which symptoms were most likely related to oropharyngeal dysphagia (OD).MethodsThe cross-sectional and multicenter study was conducted at 12 hospitals including 883 participants aged >= 65years who were fed orally and who were admitted to the physical medicine and rehabilitation outpatient clinics between September 2017 and December 2018. Demographic characteristics were recorded. Katz Daily Living Activities Index (KDLAI), swallowing-related quality of life scale (Swal-QoL) and 10-item Eating Assessment Tool (EAT-10) were used. The participants were asked the yes or no questions including swallowing difficulty of various types of food consistency with the face-to-face interview.ResultsParticipants were divided into two groups as normal swallowing (EAT-10= 3 group) (n=244) according to the EAT-10 scores. While there was no difference related to number of teeth and KDLAI scores between groups (p=0.327 and p=0.221, respectively), the significant difference was found between groups in terms of yes/no questions and Swal-QoL scores (p

Aim: To evaluate impact of pulmonary rehabilitation (PR) on quality of life (QoL) and respiratory variables in Chronic Obstructive Pulmonary Disease (COPD).Materials and methods: PR program for 3 times per week for 8 weeks were performed in patients with COPD. Breathing, upper extremity strengthening and cycle ergometry exercises were performed. PFTs, MMRC dyspnoea scale, BODE Index and 6-minute walking test (6-MWT) were evaluated baseline and after treatment in all patients with COPD. Beck Depression Inventory and State-Trait Anxiety Inventory (STAI I and II) were used for evaluating depression and anxiety and QoL was evaluated with SF-36 scale. Patients having any other cardiac or pulmonary co-morbiditites, inability for attending rehabilitation program (due to physical, physicologic or neurologic problems) were excluded. Results: A total of 50 patients were included (45 male and 5 female patients). Mean age was 59.4±8.8 (56-62). Improvement was detected in exercise capacity, dyspnea severity, QoL, anxiety, and depression levels. Improvement in PFT results were obtained after exercise program. Conclusion: PR program with cycle ergometry is effective in patients with COPD.

Background: Osteoporosis is a widespread metabolic bone disease representing a global public health problem currently affecting more than two hundred million people worldwide. The World Health Organization states that dual-energy X-ray absorptiometry (DXA) is the best densitometric technique for assessing bone mineral density (BMD). DXA provides an accurate diagnosis of osteoporosis, a good estimation of fracture risk, and is a useful tool for monitoring patients undergoing treatment. Common mistakes in BMD testing can be divided into four principal categories: 1) indication errors, 2) lack of quality control and calibration, 3) analysis and interpretation errors, and 4) inappropriate acquisition techniques. The aim of this retrospective multicenter descriptive study is to identify the common errors in the application of the DXA technique in Turkey. Methods: All DXA scans performed during the observation period were included in the study if the measurements of both, the lumbar spine and proximal femur were recorded. Forearm measurement, total body measurements, and measurements performed on children were excluded. Each examination was surveyed by 30 consultants from 20 different centers each informed and trained in the principles of and the standards for DXA scanning before the study. Results: A total of 3,212 DXA scan results from 20 different centers in 15 different Turkish cities were collected. The percentage of the discovered erroneous measurements varied from 10.5% to 65.5% in the lumbar spine and from 21.3% to 74.2% in the proximal femur. The overall error rate was found to be 31.8% (n = 1021) for the lumbar spine and 49.0% (n = 1576) for the proximal femur. Conclusion: In Turkey, DXA measurements of BMD have been in use for over 20 years, and examination processes continue to improve. There is no educational standard for operator training, and a lack of knowledge can lead to significant errors in the acquisition, analysis, and interpretation.

Aim: The primary aim of the study was to compare the serum levels of Dickkopf-1 (DKK-1) and sclerostin in patients with ankylosing spondylitis (AS) and healthy controls. The secondary aim was to evaluate the effects of anti-tumor necrosis factor alpha (TNF-α) treatments on levels of DKK-1 and sclerostin. The last aim was to evaluate any relationship between DKK-1, sclerostin, and radiologic progression in AS.Material and Method: We included 70 patients with AS (35 anti-TNF-α treated, 35 anti-TNF-α naïve) and 31 healthy controls in this study. Serum DKK-1, sclerostin, C reactive protein, and erythrocyte sedimentation rate (ESR) were assessed in patients and healthy controls. The Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Metrology Index (BASMI), and Bath Ankylosing Spondylitis Functional Index (BASFI) were calculated for the patients. Radiographs were scored according to the modified Stoke AS Spine Score (mSASSS) by an experienced radiologist who was blinded to the patients’ identity.Results: Patients with AS who were treated with anti-TNF-α agent had higher scores of BASMI and mSASSS compared with the anti-TNF-α naïve patients. Serum levels of DKK-1 and sclerostin were significantly lower in patients with AS than in healthy controls. There was a negative correlation between DKK-1 levels with ASDAS and BASMI in patients with AS. There was no correlation between DKK-1 or sclerostin levels with mSASSS. There was a positive correlation between BASMI score with mSASSS in patients with AS.Conclusion: DKK-1 levels in patients with AS were negatively correlated with BASMI, on the other hand, BASMI had a strong positive correlation with mSASSS. Therefore, these findings suggest that lower DKK-1 levels in patients with AS may play a role in new bone formation., Amaç: Bu çalışmadaki öncelikli amacımız ankilozan spondilit (AS) hastalarında ve sağlıklı kontrollerde Dickkopf-1 (DKK-1) ve sklerostinin serum düzeylerini karşılaştırmaktı. İkincil amacımız anti-tümör nekrozis faktör alfa (anti-TNF-a) tedavilerinin DKK-1 ve sklerostinin serum düzeylerine olan etkisini değerlendirmekti. Son olarak AS hastalarında DKK-1, sklerostin düzeyleri ile radyolojik progresyon arasında ilişki olup olmadığını değerlendirmeyi amaçladık.Gereç ve Yöntem: Çalışmamıza 70 AS (35 anti-TNF tedavi alan, 35 anti-TNF almayan) hastası ve 31 sağlıklı kontrol alındı. Hastalarda ve sağlıklı kontrollerde serum DKK-1, sklerostin, C-reaktif protein ve eritrosit sedimentasyon hızı ölçüldü. Ankilozan spondilit hastalık aktivite skoru (ASDAS), Bath ankilozan spondilit hastalık aktivite indeksi (BASDAİ), Bath ankilozan spondilit metroloji indeksi (BASMİ), Bath ankilozan spondilit fonksiyonel indeksi (BASFİ) hesaplandı. Radyografiler hasta bilgilerine körleştirilmiş deneyimli bir radyolog tarafından modifiye stoke ankilozan spondilit spinal skoru (mSASSS) yöntemine göre skorlandı.Bulgular: Anti-TNF-a tedavi alan AS hastalarında BASMI ve mSASSS skorları anti-TNF-a tedavi almayan hastalara göre daha yüksekti. AS hastalarında serum DKK-1 ve sklerostin düzeyleri sağlıklı kontrollere göre daha düşüktü. AS hastalarında DKK-1 düzeyleri ile ASDAS ve BASMİ arasında ters yönlü bir korelasyon vardı. DKK-1 ve sklerostin düzeyleri ile mSASSS arasında korelasyon yoktu. AS hastalarında BASMİ skoru ile mSASSS arasında anlamlı korelasyon vardı.Sonuç: AS hastalarındaki DKK-1 düzeyleri ile BASMİ arasında ters yönlü bir korelasyon vardı, diğer yandan BASMİ ve mSASSS skorları arasında güçlü bir korelasyon vardı. Bu nedenler, bu bulgular AS hastalarındaki düşük DKK-1 seviyelerinin yeni kemik oluşumunda rol oynayabileceğini düşündürmektedir.

Amac: Bu calismada, hastanemizde rehabilite edilmis spinal kord yaralanmali hastalarin epidemiyolojik ve klinik verilerinin sunulmasi, etiyolojik faktorlerin ve yuksek riskli gruplarin tanimlanmasi amaclandi. Yontemler: Ocak 2009 ile Ekim 2014 arasinda hastanemizde rehabilitasyon hizmeti almis olan 174 hastanin verileri retrospektif olarak incelendi. Yas, cinsiyet, yaralanma etiyolojisi, yaralanma seviyesi (servikal, torakal, lomber), toplam uygulanan rehabilitasyon seans sayisi, spinal cerrahi alip almadigi, American Spinal Injury Association (ASIA) evrelemesine gore fonksiyonel grubu kaydedildi. Bulgular: Hastalarin 105’i erkek, 69’u kadindi. Hastalarin ortalama yasi 36,61 ± 16,16 yil olarak bulundu. Trafik kazalari en sik yaralanma nedeniydi (n=45, %25,9), bunu yuksekten dusmeler takip ediyordu ( n=39, % 22,4). En sik torakal spinal yaralanmalar gozlendi (n=95, % 54,6). Lomber bolge ikinci sik yaralanma seviyesiydi (n=48, % 27,6). Trafik kazalarina bagli yaralanmalarda torakal seviye daha sikti (p=0,007). Basarisiz sinir cerrahisi lomber spinal yaralanmalar ile anlamli derecede iliskiliydi (p

Mumps infection has some rare complications, such as myocarditis, nephritis, pancreatitis, orchitis, and hearing problems. The main neurological complications of mumps infection are reported to be meningitis, encephalitis, myelitis, cranial nerve involvement, and, rarely, polyneuropathy. In this article, a 12-year-old male patient with mumps infection associated with acute longitudinal myelitis and Guillain-Barre syndrome (GBS) was described and discussed with the literature.

Rheumatoid arthritis (RA) is a chronic, systemic, and inflammatory disease with unknown etiology, involving peripheral synovial joints in addition to its effect on other tissues and organs (1). Although all peripheral joints may be involved in the disease, the metacarpo-phalangeal (MCF) joints, proximal interphalangeal (PIF) joints, wrists, and metatarsophalangeal (MTF) joints are the most frequently involved. In the axial skeleton, C1-C2 involvement is predominant in general, whereas sacroiliac joint involvement (SIJ) is rare (2). In this article, we present a differential diagnosis of bilateral sacroiliitis observed in a patient followed up and treated in our outpatient clinic for 2 years with a diagnosis of early RA.

Polyethylene glycol-interferon α (PEG-IFNα), used in the treatment of chronic hepatitis C, has the potential risk for serious side effects. Among the most frequent side effects are symptoms similar to flu, depression, nervousness, and bone marrow suppression. Serious neurological side effects that have an influence on the peripheral nerves are rarely reported. In this article, a 58-year-old woman with the clinical findings of Guillain-Barre syndrome in the sixth week of PEG-IFa-2a treatment is analyzed and discussed.

Aim: The aim of this study was to evaluate MPV (Mean Platelet Volume), NLR (Neutrophil-to-lymphocyte ratio), and PDW (Platelet Distribution Width) values obtained from complete blood count in patients with fibromyalgia syndrome (FMS). In addition, we aimed to investigate the relationship of these parameters with clinical conditions such as disease activity and depression.Materials and Methods: 91 patients who presented to Gaziantep University Physical Medicine and Rehabilitation department between November 2017 and March 2018 and were diagnosed with FMS according to the 2010 ACR (American Colleague of Rheumatology) criteria, and 33 healthy volunteers were enrolled in this study. Both groups filled out Fibromyalgia Impact Questionnaire (FIQ) and Hamilton Depression Rating Scale (HAM-D). Neutrophil, platelet, lymphocyte count, MPV, and PDW values were recorded from full blood count.Results: Although NLR was higher in the patient group, there was no statistically significant difference (p>0.05). While MPV and CRP values were significantly high, PDW values were significantly low in the patient group (p0.05). As the mean age values of both groups were different, a significant difference was found between the groups in terms of NLR values according to the results of regression model adjusted to age (p0.05).Conclusion: In our study, we found the NLR and MPV values to be high and the PDW values to be low, and found the NLR values to be associated with depression. The results of this study show that blood parameters can be used in FMS patients.Keywords: Inflammation; depression; fibromyalgia.

Objective: Evaluation and comparison of the efficacy of ultrasound [US] and extracorporeal shock wave therapy [ESWT] in the treatment of myofascial pain syndrome. Methods: Sixty-six patients with active myofascial trigger points in the trapezius muscle were randomized into treatment groups with US and three sessions of ESWT. Efficacy of the therapies were evaluated prior to therapy at 3 weeks and at 3 months of therapy using the Patient Global Assessment and Physician’s Global Assessment scales, Neck Pain and Disability Scale, Nottingham Health Profile, and Hamilton Anxiety Scale. Results: No severe complications were encountered with US and ESWT, and patients tolerated the therapies well overall. Statistically significant improvement was determined in the number of trigger points, pain, quality of life, and anxiety scores in post-therapy evaluations [p50.01]. Efficacy of therapies in inter-group comparison was evaluated in terms of improvement in the same scores, and the ESWT group had greater improvement when the anxiety scores were excluded [p50.05]. Conclusion: Our results indicated that both US and ESWT were effective and safe treatment modalities in myofascial pain syndrome. Three sessions of low dosage ESWT was more effective compared to US therapy that could be used as an effective and safe modality in the treatment protocols of myofascial pain syndrome.

Aim: Physiotherapy is an integral part of the management of ankylosing spondylitis (AS) and there is a needfor recommendations which focus on the rehabilitation of patients with AS. We aimed to develop recommen-dations for the physical therapy and rehabilitation of patients with AS based on the evidence and expertise.Methods: The Anatolian Group for the Assessment in Rheumatic Diseases (ANGARD) is a scientific group ofTurkish academicians (physiatrists and rheumatologists) who are experts in the rehabilitation of patients withAS. A systematic literature search summarizing the current available physiotherapy and rehabilitation trials inAS were presented to the experts before a special 2-day meeting. Experts attending this meeting first defined aframework based on the main principles and thereafter collectively constructed six major recommendationson physiotherapy and rehabilitation in AS. After the meeting an email survey was conducted to rate thestrength of the recommendations.Results: Six key recommendations which cover the general principles of rehabilitation in AS in terms of earlyintervention, initial and follow-up assessments and monitoring, contraindications and precautions, key advicefor physiotherapy methods and exercise were constructed.Conclusion: These recommendations were developed using evidence-based data and expert opinion. The imple-mentation of these recommendations should encourage a more comprehensive and methodical approach in therehabilitation of patients with AS. Regular lifelong exercise is the mainstay of rehabilitation and there is a consid-erable need for well-designed studies which will enlighten the role of physical therapy in the management of AS.Key words: ankylosing spondylitis, physiotherapy, recommendations, rehabilitation.Ankylosing spondylitis (AS) is a common inflamma-tory rheumatic disease that predominantly affects thesacroiliac joints and spine, leading to structural

We aimed to bring a more understandable and applicable technique to the literature instead of “massage therapy” in CTS. We compared our new technique with the splint wear, of which the efficacy in CTS has been proven with many studies. Eighty-four patients between 31 and 65 years of age were included in the study. The patients were divided into two equal groups. In the first group, splint and “Madenci” hand massage technique were applied, and in the second group only splint was applied. A splint was provided for all patients with tendon and nerve gliding exercises, and also when needed analgesic drugs were given. When the pretreatment and posttreatment parameters were compared via repetitive measurement analysis, it was found that PGA and MDPGA were significantly decreased in both groups (P = 0.001), whereas grip strength was significantly increased (P = 0.001). While no statistically significant difference was found between the groups regarding pretreatment values (P > 0.05), the posttreatment PGA, MDPGA, and grip strength scores were significantly improved in Group I compared to Group II (P

In this cross-sectional study, we compared frequency of hypermobility syndrome in pelvic organ prolapse (POP) patients and normal healthy Turkish women.Sixty-five women who had diagnosed as POP and ward to surgery and 52 healthy women with similar age group were included into this study.It was found that subjects with POP had a significantly higher prevalence of joint hypermobility (53.8%) when compared with normal individuals (9.6%). No significant correlation was demonstrated between Beighton scores and incontinence, exercises pattern and hormone replacement therapy.We concluded that joint laxity is associated with POP but not with urinary incontinence in Turkish women.

The objective of this study was to investigate serum paraoxonase and arylesterase activities, and lipid hydroperoxide (LOOH) and total thiol (total free sulfhydryl groups, -SH) levels along with lipid parameters in patients with knee osteoarthritis. Thirty-six patients with knee osteoarthritis and 30 healthy individuals were enrolled in the study. Serum paraoxonase and arylesterase activities were measured spectrophotometrically. LOOH levels were measured by ferrous oxidation with xylenol orange assay (FOX-2). Serum high-density lipoprotein-cholesterol (HDL-C), -SH levels, paraoxonase and arylesterase activities were significantly lower in the patient group than those in the controls (P < 0.05, for all), while LOOH and low-density lipoprotein (LDL) levels were significantly higher. In conclusion, paraoxonase and arylesterase activities were decreased significantly in patients with knee osteoarthritis. Lower serum paraoxonase-1 activity and lower level of HDL-C seem to be related to increased oxidative stress and inflammatory condition in these patients. It is known that paraoxonases reduce oxidative stress in serum and tissues thereby protecting against cardiovascular disease, particularly atherosclerosis. Thus, decreased paraoxonase and arylesterase activities play a role in the pathogenesis of atherosclerosis through increased susceptibility to lipid peroxidation in patients with osteoarthritis.

Harran University Faculty of Medicine, Department of Psychiatry, Sanliurfa, Turkey ABSTRACT Objective. Several studies and reviews have documented the high degree of comorbidity between depression and chronic pain. It was reported that chronic muscle pain is frequently accompanied by symptoms of depression. The purpose of this study was then to investigate the prevalence of major depression in chronic pain patients (CPP) with myofascial pain syndrome (MPS) and to investigate the relationship between some clinical parameters and level of depression, utilizing a healthy control group without MPS. Design/Setting/Patients. The study group consisted of 77 MPS patients (65 female, 12 male) and 72 healthy volunteers (60 female, 12 male). The diagnosis of MPS was based on clinical characteristics, examination findings, and ruling out other diagnoses. Major depressive disorder was diagnosed by a psychiatrist utilizing DSM-IV criteria. Levels of depression were obtained from the Beck Depression Inventory (BDI). Results. There was no significant difference between MPS patients and controls with respect to age and gender ( P > 0.05). The mean age of the patients was 31.1 years (SD 9.8) and the mean age of controls was 29.7 years (SD 7.1). Major depression was more frequently found in CPPs with MPS ( P < 0.001). BDI scores were higher in the MPS group than in controls ( P < 0.001). There was a significant correlation between the severity of pain and depression level in patients with MPS ( r = 0.654, P < 0.001). Conclusion. Major depression is found in MPS CPPs at a rate previously noted in the literature in mixed diagnoses CPPs. In addition, the severity of the depression may be related to perceived pain severity.

Ankylosing spondylitis (AS) is an inflammatory disorder with unknown etiology that mainly affects the axial skeleton as well as the peripheral joints and extra-articular structures. The aim of this study was to evaluate the total antioxidant status (TAS), total oxidative status (TOS) and oxidative stress index (OSI) in patients with ankylosing spondylitis (AS). Fifty AS patients with a mean Bath AS Activity Index (BASDAI) 4.6 (range 4-9.3) and 26 healthy controls were included in the study. Plasma TAS, TOS levels were determined by using novel automated methods. The OSI was calculated. Plasma TOS level and OSI values were significantly higher, and plasma TAS level was lower in patients than in healthy controls (15.8 +/- 4. 9 vs. 4.3 +/- 2.8, 12.8 +/- 3. 9 vs. 9.6 +/- 5.5, 1.2 +/- 0.03 vs. 1.8 +/- 0.2, respectively, P < 0.001 for all). There was no significant correlation between oxidant/antioxidant parameters and disease activity. The results of this study indicated that increased oxidant and decreased antioxidant capacity may be associated with the pathogenesis of AS.

We aimed to investigate the relationship between cortisol levels and bone mineral density (BMD) among premenopausal women with major depression. We compared BMD, plasma cortisol, osteocalcin and C-telopeptide (CTx) levels of 36 premenopausal women with major depression with 41 healthy women who were matched for age and body mass index. Osteocalcin and CTx were used for the evaluation of bone turnover. The clinical diagnosis of major depression was made by using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. The 21-item Hamilton Rating Scale for Depression was used for the assessment of depressive symptoms. In comparison with the controls, the mean BMD of the depressed women was significantly lower at the lumbar spine and at all sites of the proximal femur (p = 0.02, 0.01). Plasma cortisol levels were significantly higher in depressive patients than in controls (p = 0.001). Osteocalcin was lower and CTx was higher in the patient group than in controls (p = 0.04, p = 0.008). Lumbar and femur BMD scores were negatively correlated with cortisol levels in the patient group. Major depression had important effects on BMD and bone turnover markers. Depression should be considered among risk factors for osteoporosis in premenopausal women.

Background and objectives: Obstructive Sleep Apnea Syndrome (OSAS) is characterized by recurrent upper airway obstruction during sleep. The aim of this study was to investigate impact of respiratory rehabilitation program with cycle ergometer on exercise capacity, respiratory parameters, sleep and quality of life in OSAS. Patients and methods: Study population was consisted of mild and moderate OSAS patients aged 18-65. Controlled breathing techniques and respiratory muscle exercises were asked to practice 2 times a day for 10-20 minutes. Upperlimb muscles of the shoulder girdle and cycle ergometer exercise device consisting of aerobic exercise and resistance programs we implement, was performed 3 times a week for 50-60 minutes. Anthropometric measurements, respiratory function tests; exercise capacity, 6 Minute Walk Test; level of day time sleepiness the Ep worth Sleepiness Scale; sleep and quality of life, Functional Outcome of Sleep Questionnaire and the Short Form-36 Questionnaire; anxiety levels were assessed using the State-Trait Anxiety Inventory. Results: 40 patients were included in the study. After treatment, neck circumference, level of daytime sleepiness, resting and post-exercise heart rate and blood pressure response, dyspnea and leg fatigue decreased; and improved exercise capacity, MIP, quality of life and sleep were observed. Conclusion: PR may be an effective treatment option in patients with OSAS. To our knowledge this is the first report that demonstrating the effectiveness of cycling exercises on functional status, exercise capacity, life and sleep quality in patients with OSAS.

The purpose of this study was to determine serum oxidative/antioxidative status in patients with knee osteoarthritis and its relation with prolidase activity, which plays an important role in collagen metabolism. Serum antioxidative status was evaluated by measuring total antioxidant capacity (TAC), thiol level and catalase enzyme activity in patients with osteoarthritis and in healthy controls. Serum oxidative status was evaluated by measuring total peroxide (TP) and lipid hydroperoxide. Oxidative stress index (OSI) was calculated. Prolidase enzyme activity was measured to investigate the collagen metabolism. Serum TAC, thiol level, catalase activity and prolidase activity were significantly lower in patients than in controls (P < 0.001, for all). In contrast, TP, lipid hydroperoxide and OSI values were significantly higher in patients than in controls (P < 0.001 for all). Further, prolidase activity was negatively correlated with TP and OSI, and positively correlated with TAC. The present results indicate that the oxidant parameters increased and antioxidant parameters decreased in patients with osteoarthritis; therefore, these patients may be exposed to a potent oxidative stress. Decreased collagen metabolism may be related with oxidative stress, which has a role in the ethiopathogenesis and/or in the progression of the disease.

Background and Objectives: A prospective, doubleblind, randomized, and controlled trial was conducted in patients with chronic myofascial pain syndrome (MPS) in the neck to evaluate the effects of infrared low level 904 nm Gallium-Arsenide (Ga-As) laser therapy (LLLT) on clinical and quality of life (QoL). Study Design/Patients and Methods: The study group consisted of 60 MPS patients. Patients were randomly assigned to two treatment groups: Group I (actual laser; 30 patients) and Group II (placebo laser; 30 patients). LLLT continued daily for 2 weeks except weekends. Follow-up measures were evaluated at baseline, 2, 3, and 12 weeks. All patients were evaluated with respect to pain at rest, pain at movement, number of trigger points (TP), the Neck Pain and Disability Visual Analog Scale (NPAD), Beck depression Inventory (BDI), and the Nottingham Health Profile (NHP). Results: In active laser group, statistically significant improvements were detected in all outcome measures compared with baseline (P < 0.01) while in the placebo laser group, significant improvements were detected in only pain score at rest at the 1 week later of the end of treatment. The score for self-assessed improvement of pain was significantly different between the active and placebo laser groups (63 vs. 19%) (P < 0.01). Conclusion: This study revealed that short-period application of LLLT is effective in pain relief and in the improvement of functional ability and QoL in patients with MPS. Lasers Surg. Med. 35:229–235, 2004. 2004 Wiley-Liss, Inc.

Tethered cord syndrome (TCS) is a stretch-induced disorder of the spinal cord caused by congenital or acquired con-ditions. Due to improvement of imaging technique, it is currently realize that TCS may be seen with different pathol-ogy. Differing from relevant literature, concomitant presence of TCS, epidermiod cyst and lipoma in a 17 year old fe-male patient is presented and discussed in the present paper., Tethered kord sendromu (TKS) konjenital ya da edinsel nedenlerle omuriliğin gerilmesi sonucu oluşur. Manyetik Re-zonans Görüntüleme (MRG)\'nin spinal bölge rahatsızlıklarının tanısında kullanılmaya başlanması ile birlikte TKS\'nin farklı patolojilerle birlikte görülebileceği fark edilmiştir. Bu yazıda literatürden farklı olarak TKS\'nin, intradural epider-moid kist ve lipom ile birlikte ortaya çıktığı 17 yaşında bir kadın hasta anlatıldı ve tartışıldı.

Amaç: Çalışmamızda cep telefonu radyasyonuna kronik etkin kalmanın testis dokusu üzerinde meydana getireceği değişimler ve melatonin kullanımının olası koruyucu etkisinin ışık mikroskobik düzeyde incelenmesi amaçlandı. Yöntemler: 24 adet Wistar albino cinsi erkek sıçan 4 gruba ayrılarak 90 günlük deney süresince; kontrol grubuna hiçbir uygulama yapılmazken, 2. gruba her gün 30 dk 2100 MHz radyasyon uygulaması, 3. gruba her gün derialtı melatonin uygulaması, 4. gruba ise radyasyon uygulamasından 40 dk önce derialtı melatonin ve sonrasında 30 dk radyasyon uygulaması yapıldı. Deney bitiminde yüksek doz anestezi altında feda edilen deneklerden testis dokuları alındı, ağırlıkları ölçülerek ışık mikroskobik izleme yöntemlerinden geçirildi. Örneklere yapısal değişimleri incelemek amacıyla Hematoksilen Eozin, bazal membran kalınlığının değerlendirilmesi amacıyla da PAS boyamaları yapıldı; germinal epitel kalınlığı ve seminifer tübül çapı ile bazal membran kalınlığı ölçülerek istatistiksel analizler yapıldı. Bulgular: Radyasyon uygulaması ile birlikte seminifer tübüllerde düzenli yapının bozulduğu ve seminifer epitel hücreleri arasında ödem oluştuğu izlendi. Radyasyon ve melatonin uygulanan grupta seminifer tübül yapısının radyasyon grubuna karşı oldukça korunduğu dikkati çekti. Tüm gruplarda testis ağırlığında istatistiksel olarak anlamlı bir farklılık saptanmazken, radyasyon uygulanan grupta bazal membranın daha kalın olduğu, germinal epitel kalınlığının azaldığı, seminifer tübül çapının ise arttığı istatistiksel olarak belirlendi. Sonuç: Sonuç olarak yüksek doz cep telefonu radyasyonunun testis histolojik yapısına, özellikle spermatogenezis ve spermiyogenezis düzeyinde etkili olduğu belirlenirken, melatoninin koruyucu özellik gösterdiği kanısına varıldı.

Sleep problems in rehabilitation patients have not yet understood. Age, physiological, or environmental condition may affect sleep habits. Sleep problems occur frequently in the general population, and are even more common in individuals with spinal cord injury (SCI). SCI patients have restless sleep, complain of spasms, difficulty in initiating and maintaining sleep, snoring, often awaking in the early hours of the morning and are unable to fall asleep again, and during the day time they are tired and sleepy. Patients with SCI often say they sleep less or don?t feel rested when they wake up. Studies have been reported that sleep disturbances have potential negative impact and sleep disorders can hinder the rehabilitation process and affect global outcomes in patients with spinal cord injury. It is important to assess the presence of sleep problems in SCI patients, and to provide effective treatments when indicated for their compliance of rehabilitation program and increasing quality of life.

Ozet Otoimmun inflamatuvar hastaliklarin etiyopatojenezinde TNFα’nin onemli rolu oldugu ve tedavide anti-TNF-α ilaclarin yillardan beri kullanildigi bilinmektedir. Bununla birlikte bu ilaclarin kullanimi sirasinda farkli otoimmun hastaliklarin ortaya cikmasi gibi istenmeyen sonuclarla karsilasilabilmektedir. Bu yazida romatoid artrit tanisiyla adalimumab kullandigi donemde bulloz pemfigoid tablosu gelisen bir kadin hasta anlatildi ve tartisildi. (Turk J Rheumatol 2010; 25: 214-6) Anahtar sozcukler: Bulloz pemfigoid, anti TNF-alfa, romatoid artrit

Background Tuberculosis of the musculoskeletal system is not a common clinical condition; however, multifocal bone involvement is even rarer and difficult to recognize. Case In this paper, we presented a patient who developed paraplegia 15 days before his hospital admission. He was operated by neurosurgeons due to spinal mass, but postoperative examination revealed vertebral and multifocal skeletal tuberculosis. It is difficult to diagnose this condition by conventional imaging methods. The importance of positron emission tomography (PET) in the diagnosis of skeletal tuberculosis was emphasized. Result The importance of rehabilitation program in restoring functionality was overviewed in the light of current literature. Vertebral and osteoarticular tuberculosis should be considered in patients with vertebral and thoracic mass presenting with neurological deficits.

Physiotherapy is an integral part of the management of ankylosing spondylitis (AS) and there is a need for recommendations which focus on the rehabilitation of patients with AS. We aimed to develop recommendations for the physical therapy and rehabilitation of patients with AS based on the evidence and expertise. The Anatolian Group for the Assessment in Rheumatic Diseases (ANGARD) is a scientific group of Turkish academicians (physiatrists and rheumatologists) who are experts in the rehabilitation of patients with AS. A systematic literature search summarizing the current available physiotherapy and rehabilitation trials in AS were presented to the experts before a special 2-day meeting. Experts attending this meeting first defined a framework based on the main principles and thereafter collectively constructed six major recommendations on physiotherapy and rehabilitation in AS. After the meeting an email survey was conducted to rate the strength of the recommendations. Six key recommendations which cover the general principles of rehabilitation in AS in terms of early intervention, initial and follow-up assessments and monitoring, contraindications and precautions, key advice for physiotherapy methods and exercise were constructed. These recommendations were developed using evidence-based data and expert opinion. The implementation of these recommendations should encourage a more comprehensive and methodical approach in the rehabilitation of patients with AS. Regular lifelong exercise is the mainstay of rehabilitation and there is a considerable need for well-designed studies which will enlighten the role of physical therapy in the management of AS.

Fibromyalgia Syndrome (FMS) is one of the most frequent rheumatologic conditions, its main characteristic being chronic diffuse musculoskeletal pain and hyperalgesia, likely due to altered central processing of pain (1). Fibromyalgia symptoms are not restricted to pain. Besides the painful setting, these patients often complain of fatigue, sleep disturbances, morning stiffness, and paresthesia on the extremities, subjective edema sensations and cognitive disturbances. Many patients experience cognitive dysfunction known as "fibrofog" which may be characterized by impaired concentration. Cognitive symptoms in these patients may be exacerbated by the presence of depression, anxiety, sleep problems, endocrine disturbances, and pain. Association with other comorbidities is often found, contributing to the suffering and decline in quality of life of these patients. Among the most frequent comorbidities found, it can be mentioned depression, anxiety, chronic fatigue syndrome, myofascial syndrome, irritable bowel syndrome and nonspecific urethral syndrome (2). Various researches show that there were relation between chronic pain and cognitive dysfunction in FM patients. Managing chronic pain may take some cognitive effort and this may interfere with performance on cognitive tasks. This is important because even though FMS patients report cognitive symptoms, physicians and scientists must consider the possibility that because FM patients experience many symptoms, there may be a tendency to mistake normal, everyday lapses on cognition as something more serious (3).

Amaç: Bu çalışmada amaç, Fiziksel Tıp ve Rehabilitasyon (FTR) polik liniklerine başvuran geriatrik hastaların demografik ve klinik özelliklerini belirlemek, bu klinik ve demografik özelliklerin, yaş, cinsiyet ve öğrenim düzeylerine göre farklılıklarını ortaya çıkarmaktı. Gereç ve Yöntem: Çok merkezli çalışma kapsamına 20 FTR polikliniğine başvuran 65 yaş üzeri toplam 820 hasta alındı. Demografik verilerin yanın da; yakınmaları, hastalıkları, ağrı düzeyleri, kullandıkları ilaçlar, alışkanlıkları ve tıbbi durumları kaydedildi. Yaş, cinsiyet ve öğrenim düzeyinin yakın malar, hastalıklar ve alışkanlıklar üzerindeki etkisi araştırıldı. Bulgular: Hastaların yaş ortalaması 71,7±5,5 yıl idi. %16,7’si tek başına yaşıyordu, %61,7’si ev hanımı idi. %86'sının bir veya daha fazla komorbid hastalığı mevcuttu; en sık hipertansiyon (HT) daha sonra mide ve kalp hastalıkları görülmekte idi. En sık yakınma nedenleri sıklığı sırasıyla eklem ağrısı, halsizlik-yorgunluk, yaygın vücut ağrısıydı. Günde yutulan ilaç sayısı ortalama 4,02±0,9 (ortanca 4), VAS'a göre ağrı ortalaması 5,1±1,3 (ortan ca 5) olarak belirlendi. %16,5’nin düşme öyküsü mevcuttu. %30,1’i yürüyüş yapıyor ve sadece %15,4’ü ev içinde egzersiz yapıyordu. Omurga deformitesi, omurga ağrısı, idrar kaçırma, görme sorunu, yutma güçlüğü, duymada azalma, denge ve diş sorunu 75 yaşın üzerindekilerde istatistiksel açıdan anlamlı olarak daha fazla görülmekteydi. Sonuç: FTR polikliniklerinde hastaların çoğunluğunu yaşlı popülasyon oluş turmaktadır. İleri yaş grubunda komorbid hastalıkların varlığı, kullanılan ilaç sayısının fazla olması, osteoporoz ve düşme sıklığının artması, FTR heki minin hem medikal tedavi planlama aşamasında ve hem de rehabilitasyon programı hazırlarken dikkatli davranmasını gerektirmektedir. İleri yaş grubunun günlük yaşamlarında bağımsız ve daha aktif olabilmesi için sadece kas-iskelet yakınmaları değil, bütün organ sistemleri değerlendiril erek kapsamlı ve çok yönlü bir geriatrik rehabilitasyon programı düzenlen melidir. Türk Fiz Tıp Rehab Derg 2011;57:143-9., Aim: The aim of this study was to define the demographic and clinical characteristics of geriatric patients who referred to physical medicine and rehabilitation (PMR) outpatient clinics and to detect the differences between these characteristics in regard to age, sex and education level. Materials and Methods: 820 patients over 65 years old who attended 20 outpatient clinics were included in the study. In addition to demographic data, the complaints, comorbid diseases, pain levels, drugs being used, exercise and medical status of the patients were recorded. The effects of age, sex and education level on complaints, comorbid diseases and exercise habits were investigated. Results: The mean age of the patients was 71.7±5.5 years. 16.7% were living alone, 61.7% were housewives. 86% of the patients had one or more comorbid diseases - hypertension, gastric problems and heart disease were mostly encountered. The most common complaints were joint pain, fatigue and widespread body pain. The average number of pills taken per day was 4.02±0.9 (median 4), and the VAS pain score was 5.1±1.3 (median 5.0). History of falling was present in 16.5% of patients. 30.1% were routinely walking and 15.4% were performing exercise at home. In patients over 75 years, vertebral pain and deformity, urinary incontinence, eye problem, difficulty in swallowing, decrease in hearing, as well as balance and teeth problems were significantly more frequent than in younger subjects. Conclusion: Aged population constitutes most of the PMR outpatient clinic patients. Considering comorbid diseases, high number of daily taken drugs and falls, PMR specialist should be cautious in prescribing drugs and planning rehabilitation programme. For independence in activities of daily living in this age group, besides the musculoskeletal system, all other systems should be evaluated and a comprehensive geriatric rehabilitation programme should be constructed. Turk J Phys Med Rehab 2011;57:143-9.

Spasticity can cause development of contractures, leading to extra physical disability. Spasticity mostly occurs in disorders of the central nervous system, such as spinal cord injury, cerebral palsy, or hemiplegia. The caregivers of spastic patients have to face problems, such as maintaining hygiene and dressing. Otherwise, the ability to stand or walk usually relies on degree of the spasticity. Although, the mechanisms of extracorporeal shock wave therapy (ESWT) on spasticity are still unknown, there are a few studies on this topic in the medical literature. In this study, we described a significant reduction in hypertonia in the plantar flexors after shock wave therapy in patients with spasticity. Fifteen patients (5 males and 4 females) with spasticity were included in the study. The mean age of our patients was 25.6 years. Three patients had hemiplegia, 2 patients had cerebral palsy, and 4 patients had spinal cord injury. Spasticity was upward of than grade II, by modified Ashworth scale (MAS), in all patients. Spasticity was evaluated by MAS from 0 to 4 (0: no spasticity to 4: severe spasticity) on muscles 4 hours after exercises. In each subject, clinical measures were evaluated before and 2 weeks after the ESWT. Rehabilitation sessions varied in length from 30 to 60 minutes. Ankle-foot orthoses were given to all patients; inhibitor hand splint were used in patients with hemiplegia. ESWT was planned for reduction of spasticity, improving compliance with an exercise program. Reduction in physical activities in patients with spasticity leads to low endurance, deconditioning increased heart rates and energy costs. ESWT was applied in the first week of physiotherapy sessions every other day, 3 sessions in total. Rehabilitation programs continued after ESWT. Shock wave therapy instrument BTL® -5000 Power was used for ESWT. The pressure pulses were focused on the spastic side of upper and lower muscles. Shots (2000) were given in the belly of the muscles, and the intensity was 0.1 mJ/mm2 (2 bars).

We report a 55-year-old woman with late onset spondyloarthropathy who had widespread body pain and pitting oedema of both ankles. She had been followed up for polymyalgia rheumatica for nearly 10 years. On laboratory examination, ESR: 62 mm/h and CRP: 16.1 mg/dl. HLA was positive. There was tenderness on both of her ankles. We diagnosed late onset spondyloarthropathy according to clinic and radiographic findings. The patient was treated with sulphasalazine 200 mg/day and indomethacin 100 mg/day. As a conclusion, LoSPA may mimic a variety of rheumatic conditions such as PMR and reflex sympathetic dystrophy syndrome. Careful examination should be warranted in such conditions.