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A 13-year-old adolescent girl with symptoms of fever, headache, vomiting and suddenly developed stroke at face admitted to emergency department. On her physical examination, exudative tonsillitis, bilateral facial palsy (BFP), and meningeal irritation signs were detected. The diagnosis of meningitis was excluded by normal lomber puncture. Acute Epstein-Barr virus (EBV) infection was diagnosed by a positive Monospot test and high EBV early antigen immunoglobulin M titers. In cranial diffusion magnetic resonance imaging pathological contrast enhancement of left facial nerve was detected. Complete axonal degeneration at left half of face and mild axonal degeneration at right half of face were detected in electroneuromyography. She partially recovered from BFP after a year of duration despite extensive physical exercise programme.

The aim of this study was to investigate whether women giving preterm birth have joint hypermobility.The study included 44 women giving preterm birth (study group) and 48 women with the history of term birth (control group). After demographic data were recorded, the presence of joint hypermobility based on the Beighton diagnostic criteria and subgroup scores were noted down. Total Beighton scores were compared between the study and control groups.The total Beighton scores were significantly higher in the study group (It should be kept in mind that joint hypermobility detected during follow-up of pregnancy can be related to the risk of preterm birth. Informing pregnant women with joint hypermobility about the possibility of preterm birth could be helpful.

Demonstrate of accidental intravascular injection during lumbar transforaminal anterior epidural steroid injection (TAESI) performed with three-dimensional imaging angiography (3DIA) and fluoroscopy.We assessed 20 (9 males and 11 females) patients (with a total of 40 levels) whose images were received with simultaneously 3DIA and fluoroscopy-guided TAESI between January 2016 and September 2016 as retrospective. Injections were carried out in the lumbar fourth intervertebral space bilaterally and performed in the same way all of the cases.The mean age and body mass index of the patients were 47.9±2.72 years and 26.95±1.21, respectively. There were 10 patients with disc herniation, seven patients with spinal stenosis, and three patients with failed back surgery syndrome. In 3D imaging, vascular escape was detected in the 7 levels (17.5%) which were thought to be no escape in the fluoroscopy imaging.In chronic lumbar radiculopathy patients, intravascular escapes may occur during the fluoroscopic TAESI procedure. To avoid intravascular injections during TAESI procedure, it may be appropriate to use different imaging methods that can give more detailed results such as 3D angiography.

Background : : Development of methods to accelerate nerve regeneration in peripheral nerve damage is important. Electroacupuncture is a new therapeutic method that combines traditional acupuncture with modern electrotherapy. Melatonin has been shown to reduce nerve damage. Objectives: In this study, we aimed to determine and compare the therapeutic effects of electroacupuncture and melatonin on rat sciatic nerve injury. Methods : : A total of 56 adult male Wistar Albino rats were divided into four study groups with 14 animals in each group: intact control (group I), subcutaneous saline (group II), subcutaneous melatonin (group III), and electroacupuncture (group IV). Surgical procedure including unilateral (right) sciatic nerve injury was applied to groups II, III, and IV. Saline and melatonin started immediately after surgery for six weeks, while electroacupuncture was given two weeks after surgery for 3 weeks. Functional and histological assessments were used as outcome measurements. Results : : Sciatic nerve damage caused a significant decrease in nerve conduction velocity. Both electroacupuncture treatment and melatonin treatment significantly increased the nerve conduction velocity. Both sciatic functional recovery and histological regeneration were faster in these treatment groups compared to the saline. However, no significant difference was observed between the two treatment groups. Conclusion : : Electroacupuncture and melatonin are promising alternative treatment strategies for peripheral nerve damage and can be examined in detail in future studies.

Objectives Demonstrate of accidental intravascular injection during lumbar transforaminal anterior epidural steroid injection (TAESI) performed with three-dimensional imaging angiography (3DIA) and fluoroscopy. Methods We assessed 20 (9 males and 11 females) patients (with a total of 40 levels) whose images were received with simultaneously 3DIA and fluoroscopy-guided TAESI between January 2016 and September 2016 as retrospective. Injections were carried out in the lumbar fourth intervertebral space bilaterally and performed in the same way all of the cases. Results The mean age and body mass index of the patients were 47.9±2.72 years and 26.95±1.21, respectively. There were 10 patients with disc herniation, seven patients with spinal stenosis, and three patients with failed back surgery syndrome. In 3D imaging, vascular escape was detected in the 7 levels (17.5%) which were thought to be no escape in the fluoroscopy imaging. Conclusion In chronic lumbar radiculopathy patients, intravascular escapes may occur during the fluoroscopic TAESI procedure. To avoid intravascular injections during TAESI procedure, it may be appropriate to use different imaging methods that can give more detailed results such as 3D angiography.

Synovial cysts are benign soft-tissue tumors that arise from synovial joints or tendon sheaths. Synovial cyst of proximal tibiofibular joint is a very rare condition, which is included in non-traumatic causes of peroneal nerve palsy. This article presents clinical, and radiological findings of peroneal nerve palsy in a 50-year-old male patient admitted with sudden drop foot. Based on the clinical examination, electroneuromyography data, magnetic rezonans image the compression of nerve by synovial cyst was confirmed. Peroneal nerve palsy was completely improved after surgical resection of synovial cyst and physical theraphy and rehabilitation. In conclusion, synovial cysts of proximal tibiofibular joint causing peroneal nerve palsy should be remembered as a possible differential diagnosis for patient with drop foot.

Objective: To evaluate the role of intermittent pneumatic compression in the treatment of breast cancer–related lymphoedema. Design: Randomized controlled trial. Setting: Physical medicine and rehabilitation clinic at a university hospital. Subjects: Seventy-six patients with lymphoedema. Interventions: Patients were allocated into Group 1 (complex decongestive treatment, n = 38) and Group 2 (complex decongestive treatment + intermittent pneumatic compression, n = 38). The complex decongestive treatment involved skin care, manual lymphatic drainage, compression bandaging, and exercise for 20 sessions. Group 2 additionally received intermittent pneumatic compression. Main measures: Quantitative outcomes consisted of volumetric measures prior to and after the treatment. Clinical assessments included severity of pain, heaviness and tightness, disability, grip strength, and depression. Results: Lymphoedema was similar at baseline, but treatments significantly reduced the excess volume (from 373 mL to 203 mL in Group 1 and 379.5 mL to 189.5 mL in Group 2). Percentage excess volumes (PEVs) decreased in both groups. The percentage reduction of excess volume was better in Group 2 than Group 1, but the intergroup difference was not significant. The clinical scores reflected improvements, but the heaviness and tightness read significantly lower in Group 2 than Group 1. Conclusion: Intermittent pneumatic compression seems to add no benefit when combined with complex decongestive treatment of lymphoedema, but, may be functional in reducing the sensations of heaviness and tightness for the patients with pitting oedema.

Objectives This study aims to investigate the potential relationship between joint laxity and postural balance by using tetra-ataxiometric posturography (Tetrax®). Patients and methods A total of 69 healthy volunteers were included in the study and classified into three groups based on their hypermobility severity determined with Beighton-Horan hypermobility index scores. Of those, 29 participants were non-hypermobile, 13 participants were mildly hypermobile and remaining 27 patients had severe hypermobility. Postural control of the participants was evaluated by using the Tetrax® device in eight different positions. The stability index, Fourier index, weight distribution index, and synchronization index scores of each participant were recorded. Results We found that the participants with severe hypermobility exhibited significantly higher stability index scores while the position of the head is extended and rotated right. The weight distribution index on elastic surfaces was impaired in non-hypermobile and severely hypermobile participants. We observed that the Fourier Index scores were higher at a higher-medium frequency (0.5-1 Hz) in participants with severe hypermobility. There was no difference between the groups in terms of synchronization index scores. Conclusion These findings suggest that severely hypermobile individuals have a decreased postural stability in head-extended and head- rotated positions when compared to individuals who are non-hypermobile. This increased instability may lead to an increased risk of musculoskeletal injuries, especially in sports that require extension and rotation movements of the head.

Epidural lysis is known to be one of the therapy methods used following an unsuccessful low back surgery. Despite its proven effectiveness, several complications associated with epidural lysis procedure have been reported. The most common complications are dural perforation, breaking of the catheter and infections. Cauda equina syndrome is a rare complication seen after epidural lysis. A 51-year-old female complaining of lower back pain for six years underwent an epidural lysis procedure at the lumbar 3-4-5 level. Following the procedure, the patient was not able to walk due to weakness starting in both lower extremities, besides, she had fecal and urinary incontinence. After being diagnosed with cauda equina syndrome, a rehabilitation program was administered. After three months, the patient was ambulant with a bilateral dynamic carbon fiber ankle foot orthoses and a walker. It should be kept in mind that serious complications such as cauda equina syndrome, which may considerably affect the patients’ quality of life in a negative way, might develop after an epidural lysis procedure.

Background: Generalized joint laxity is often associated with gait deviations. The aim of this study was to investigate the static and dynamic loading pattern of the foot with increasing joint mobility and to discuss the potential impact of this condition on the plantar loading patterns. Methods: Seventy female participants between ages of 18 and 30 were included in this cross-sectional survey. The Beighton-Horan Joint Mobility Index scores were assessed and participants divided into 3 categories: no hypermobility (NH) group, scores 0 to 2; moderate hypermobility (MH) group, scores 3 to 4; distinct hypermobility (DH) group, scores 5 to 9. Pedobarographic analysis was performed both in static and walking conditions. Dynamic foot loading examined in 10 anatomic zones. Contact areas of forefoot, midfoot, and rearfoot were recorded. Results: In the dynamic pedobarographic analysis, individuals with distinct joint hypermobility displayed higher peak pressure and maximum force values under the hallux, compared with other groups ( P < .05). The maximum force value of the second metatarsal was higher in the DH group than in the MH group ( P < .05). Conclusion: Our study results suggest that plantar loading pattern differs with increasing degrees of the hypermobility score. Clinical Relevance: Differences in plantar loading parameters in people with severe joint mobility scores may be useful in interpreting the foot pathologies of these individuals.

Objectives To compare the efficacy of intra-articular injection and radiofrequency (RF) neurotomy of genicular nerves in patients with chronic knee osteoarthritis (OA) pain. Methods Seventy-three patients with knee OA were included in the study. Patients were randomly assigned to Group IA (intra-articular 2.5 mL of bupivacaine, 2.5 mg of morphine and 1 mL of betamethasone, 6 mL of fluid injection) or Group RF (RF neurotomy of the genicular nerves). The outcome measures included a pain scale (visual analog scale, VAS) and Western Ontario and McMaster Universities (WOMAC) Index of Osteoarthritis. Results No statistically significant difference was found between the two groups in baseline VAS-pain. In Group RF, a significant reduction was observed in VAS-pain at the first month (P < 0.001) and the third month (P < 0.001) in comparison to Group IA. Also in Group RF, a significant reduction was observed in WOMAC total scores in the first month (P < 0.001) in comparison to Group IA. Conclusion This study is the first controlled study in the literature which compares RF genicular nerve to intra-articular injections. This study demonstrated that genicular nerve RF neurotomy is a safe and efficient treatment modality and provides functional improvement along with an analgesia in patients with chronic knee OA.

This study aimed to perform genicular nerve RF neurotomy using two different imaging methods, fluoroscopy and ultrasound, and to compare the clinical effects and reliability of the two methods. Fifty patients with osteoarthritis were included in this study. Patients were randomly allocated into group 1 (fluoroscopy imaging) and group 2 (ultrasound imaging). Outcomes were measured using a pain scale (visual analog scale; VAS) and the Western Ontario and McMaster Universities (WOMAC) Index of Osteoarthritis. The application time in the ultrasound group (20.2 ± 6.4 min) was shorter than in the fluoroscopy group (25 ± 4.8 min) (p

Osteoarthritis (OA) is the most common degenerative joint disease. OA affects millions of individuals each year and becoming the most important cause of pain in geriatric population. Progressive destruction of articular cartilage is one of the prominent features of the disease. The diagnosis of OA is generally based on clinical and radiographical findings, which are insufficient to determine early-stage OA and predict disease course. There is a need for biomarkers that help clinicians early diagnose, assess disease activity, predict prognosis and monitor response to therapy. There are a growing number of publications regarding candidate markers in this field. The aim of this paper was to review recent studies on biochemical markers that reflect cartilage, synovial and bone turnover and their clinical use in patients with OA.

[Purpose] Physiotherapeutic heating agents are classified into two groups: superficial-heating agents and deep-heating agents. Therapeutic ultrasound is a deep-heating agent used to treat various musculosketal disorders. Numerous studies have attempted to determine the impact of ultrasound on healthy nerve conduction parameters. However, the instantaneous effects of deep heating via ultrasound on demyelinating nerves do not appear to have been described previously. The present study aimed to assess and compare the impact of ultrasound on demyelinating nerve and healthy nerve conduction parameters. [Subjects and Methods] Carpal tunnel syndrome was used as a focal demyelination model. Thirty-two hands of 25 participants with carpal tunnel syndrome were enrolled in the study. Ultrasound parameters were 3.3 MHz, 1.0 W/cm(2), 8 minutes, and continuous wave. Electrodiagnostic studies were performed initially, at the midpoint (4th min), and immediately after (8th min) ultrasound application. [Results] Reduced motor conduction velocity was found in demyelinating nerves at the 4th and 8th minutes. Ulnar nerve onset latency was significantly prolonged in the 8th minute recording, compared to the initial value. There were no significant differences in relative velocity and latency changes between demyelinating and normal nerves. [Conclusion] Deep heating via ultrasound may inversely affect conduction velocity in demyelinating nerves.

Sarı, Erhan (Balikesir Author), Sexual dysfunction is a common experience in women with fibromyalgia. However, the physiopathology of this association is unclear. We aimed to evaluate whether sleep disturbance has an influence on sexual function in women with fibromyalgia. Fifty-four sexually active premenopausal women with fibromyalgia were enrolled in the study. The following questionnaires were used: the Female Sexual Function Index (FSFI), the Pittsburgh Sleep Quality Index (PSQI), the Fibromyalgia Impact Questionnaire (FIQ) and the Beck Depression Inventory (BDI). Appropriate statistical analyses were used by using SPSS 18. The mean FSFI score was 25.344 +/- 6.52 and showed no correlation with age, body mass index, BDI or duration of fibromyalgia. However, a positive correlation between sexual dysfunction and low sleep quality was found (r = 0.43; P = 0.001). In addition, the median FSFI score was 29.2 (27.2-32.4) in patients with higher sleep quality (PSQI 5) (P

Background Ankylosing spondylitis is one of the most common inflammatory rheumatic diseases and is associated with alterations in posture. The aim of this study was to investigate the pedobarographic changes among ankylosing spondylitis patients, in an attempt to understand whether the alterations in the posture affect the plantar pressure distribution. Methods The study population consisted of 38 patients with ankylosing spondylitis and 33 healthy volunteers. The static and dynamic pedobarographic measurements were performed to determine the plantar pressure distribution. Moreover, the Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, Ankylosing Spondylitis Quality of Life Questionnaire and Bath Ankylosing Spondylitis Metrology Index were used to assess the clinical state of the patients. Results The static pedobarographic measurements did not reveal any intergroup difference. There were differences between the groups in the results of dynamic peak pressure measurements under the metatarsal areas and under the midfoot region. The percentage of the midfoot in the dynamic plantar contact area was higher in ankylosing spondylitis patients in comparison to the controls. No clinically significant correlation was found between the clinical scores and static pedobarographic measurements. The plantar pressures under the metatarsal heads, medial and lateral heel regions declined with increasing disease activity according to the Bath Ankylosing Spondylitis Disease Activity Index scores. The lower peak pressures on the forefoot and rearfoot, were associated with the higher Bath Ankylosing Spondylitis Metrology Index scores of the patients. Interpretation The alterations in the posture may have effects on the plantar pressures in patients with ankylosing spondylitis, especially during dynamic activities.

Sinovyal osteokondromatozis, sinovyumun kartilajenoz proliferasyonu ile karakterize nadir gorulen bir hastaligidir (1). Sinovyal osteokondromatozis ayni zamanda sinovyal kondrometaplazi, sinovyal kondrozis ya da sinovyal kondromata olarak da isimlendirilmektedir. Etyolojisi bilinmemekle birlikte, travma ya da enfeksiyona bagli sinovyal irritasyon sonucu gelisebilecegi dusunulmektedir. Sinovyumun villoz, noduler kikirdak metaplazisi sonucu sinovyal membran, bursa ve tendon kilifinda kartilajenoz veya osteokartilajenoz noduller olusmaktadir. Eklem, sinovyal membraninda olusan nodullerin koparak serbest hale gelmesi sonucu sinovyumda multipl, kartilajenoz veya ossifiye noduller meydana gelmektedir (2). Sinovyal osteokondromatozisin, primer ve sekonder olmak uzere iki tipi bulunmaktadir. Primer sinovyal osteokondromatozis, hemen daima monoartikuler olup buyuk eklemleri tutmaktadir. Tani, yasamin 3. ve 4. dekatlarinda konulmakta ve bayanlara gore erkeklerde daha sik gorulmektedir. Genellikle diz, dirsek, omuz ve kalcada daha cok gorulmekle birlikte, tum sinovyal eklemleri tutabilmektedir. Daha sik gorulen sekonder formu ise, ileri yaslarda ve travma, osteoartrit, osteokondritis dissekans veya noropatik artropati gibi patolojiler sonrasinda gorulmektedir (3). Benign bir hastalik olmakla birlikte, nadiren malign transformasyon da gosterebildigi bildirilmistir (4,5). Sinovyal osteokondromatozisin tedavisinde siklikla tercih edilen yontem, cerrahi ile serbest intraartikuler cisimlerin cikarilmasi ve tutulan sinovyumun komplet rezeksiyonudur. Bu yazida, nadir gorulen ve fizik tedavi ve rehabilitasyon uygulamalari ile klinik ve fonksiyonel durumda olumlu sonuclar aldigimiz sinovyal osteokondromatozis tanili bir olgu sunulmustur. Olgu Sunumu

AMAC: Karpal tunel sendromu (KTS) median sinirin el bilegi duzeyindeki tuzak noropatisidir. Geceleri siddetlenen agri ve dizesteziler hastaligin tipik bulgusudur. Calismamizin amaci KTS hastalarinda uyku kalitesinin arastirilmasi, mevcut uyku bozukluklarinin semptom siddeti ve fonksiyonel bozuklukla iliskisinin saptanmasidir.GEREC VE YONTEMLER: Elektrodiagnostik olarak KTS tanisi alan 29 kisi ve kontrol grubu olarak hastane personelinden 25 saglikli kisi calismaya alindi. Tum katilimcilarin bilgilendirilmis onami alindi. Hastalarin semptom siddeti ve fonksiyonel bozukluklarini degerlendirmek uzere Boston sorgulamasi kullanildi. Calismaya katilan hastalarin ve saglikli kontrol grubunun uyku kalitesi Pittsburgh Uyku Kalitesi Indeksi ile degerlendirildi.BULGULAR: Karpal tunel sendromlu hastalarin genel uyku kalitesinin kontrol grubuna kiyasla anlamli olarak daha kotu oldugu saptandi (p=0,046). Pittsburgh skoru bilesenleri ayrintili olarak degerlendirildiginde alisilmis uyku etkinliginin karpal tunel sendromlu hastalarda anlamli duzeyde bozulmus oldugu saptandi (p=0.001). SONUC: Uyku kalitesi KTS’li hastalarda anlamli duzeyde bozulmaktadir ve gece uykuda gecirdikleri toplam sure azalmaktadir

Individuals with autism spectrum disorder (ASD) have distinctive needs with respect to sexual development and education. This pilot study evaluates the effectiveness of a parent-implemented Social Story intervention with an embedded visual task analysis to teach menstrual care skills to three young girls with ASD. Skill generalization was evaluated using two different types of pads and a simulated condition (i.e., a pad with red syrup). Social validity of target behaviors, intervention procedures and intervention effects were evaluated. Additionally, qualitative changes in participant behaviors were measured via phone interviews with the participants’ mothers (Bruess and Greenberg 1994) 1 year later. Results indicate that participants were more knowledgeable about reproductive development and were able to independently care for their menses regardless of pad type (wings vs. no-wings) and condition (clean vs. dirty). Parents reported high satisfaction with the intervention procedures and outcomes. Implications of the study and future research are discussed.

This study utilised a structured analogue method to evaluate factors which impact preschool teachers’ preference for language interventions. These factors included type of treatment approach (naturalistic versus therapeutic), person delivering the intervention (classroom teacher versus speech and language pathologist), and severity of language delay (mild versus severe). Survey participants included 29 preschool special education teachers, five of whom volunteered to complete follow-up interviews. Results demonstrate that teachers prefer naturalistic over therapeutic approaches overall. When stratified by severity of the language delay, teachers rated the three intervention approaches differently. Implications of these findings for research and practice are discussed.

Address for Correspondence: Dr. Yasemin Turan, Adnan Menderes Universitesi Tip Fakultesi, Fiziksel Tip ve Rehabilitasyon Anabilim Dali, Aydin, Turkey Phone: +90 256 444 12 56 E-mail: yasemin_dincer@yahoo.com doi: 10.5152/tjr.2010.32 Ozet Romatolojik hastaliklarda cakisma sendromlu hastalara siklikla rastlanilmakla birlikte, Behcet hastaligi ve ankilozan spondilit hastaliginin birlikteligi olan az sayida olgu vardir. Bu sebeple, biz bu makalede Behcet hastaligi ve ankilozan spondilit birlikteligi olan HLA B5 pozitifligi, HLA B27’nin negatif oldugu, oral ve genital bolgede lezyonlari bulunan 55 yasindaki erkek hastayi literaturler esliginde sunmayi amacladik. (Turk J Rheumatol 2010; 25: 217-20) Anah tar soz cuk ler: Ankilozan spondilit, behcet hastaligi

Ozet Eozinofilik fasiit, periferik eozinofili, fasiit ve “Groove” isareti ile karakterize nadir gorulen bir durumdur. Periferal kanda eozinofili ve ozellikle ekstremitelerde skleroderma benzeri deri endurasyonlari bu hastaligin karakteristik ozellikleridir. Sistemik organlar genellikle etkilenmemistir. Bu yazida, uzun sure tani konamayan ve kas biyopsisi sonrasi eozinofilik fasit tanisi koydugumuz 35 yasindaki erkek olgunun klinik ozellikleri ve hastalik hakkinda yaptigimiz literatur taramasinin sonuclari sunulmustur. (Turk J Rheumatol 2010; 25: 208-13) Anahtar sozcukler: Eozinofilik fasiit, groove isareti Al›nd›¤› Tarih: 05.11.2008 Kabul Tarihi: 05.12.2008 Abst ract Eosinophilic fasciitis is a rare entity characterized by peripheral eosinophilia, fasciitis and “groove sign”. The characteristic features of this inflammatory disease include scleroderma-like skin indurations, predominantly on the extremities, and peripheral blood eosinophilia. Systemic organs are generally not affected. In this paper, we present the clinical characteristics of a 35-year-old male patient who could not be diagnosed for a long period and was diagnosed as eosinophilic fasciitis following muscle biopsy. We also include herein the results of our literature survey regarding this disease. (Turk J Rheumatol 2010; 25: 208-13)

GUNDUZ, Osman H/0000-0002-3214-803X; Ayhan, Fikriye Figen/0000-0001-6906-991X; Duruoz, Mehmet Tuncay/0000-0003-3584-2788; Ataman, Sebnem/0000-0003-3570-3825; NAS, Kemal/0000-0002-5845-0851 WOS: 000299007300027 PubMed: 20711591 A web-based application patient follow-up program was developed to create a registry of patients with ankylosing spondylitis (AS) by the Turkiye Romatizma Arastirma Savas Dernegi (TRASD) AS Study Group. This study describes the methodological background and patient characteristics. The patient follow-up program is a web-based questionnaire, which contains sections on socio-demographic data, anamnesis, personal and family history, systemic and musculoskeletal examination, laboratory and imaging data and treatment. Between October 1, 2007 and February 28, 2009, 1,381 patients from 41 centers were included in the registry (1,038 males [75.2%]; mean age 39.5 +/- A 10.7 years). Mean disease duration was 12.1 +/- A 8.5 years, and mean time from initial symptom to diagnosis was 5 +/- A 6.8 years (median 2 years). HLA-B27 positivity was detected in 73.7% of 262 patients tested. Manifestations of extraarticular involvement were anterior uveitis (13.2%), psoriasis and other skin and mucous membrane lesions (6%) and inflammatory bowel disease (3.8%). The prevalence of peripheral arthritis was 11.2%. In 51.7% of patients, the Bath AS Disease Activity Index was a parts per thousand yen4. But since our patients consisted of the ones with more severe disease who referred to the tertiary centers and needed a regular follow-up, they may not represent the general AS population. Disease-modifying anti-rheumatic drugs were being used by 41.9% of patients, with 16.4% using anti-TNF agents. TRASD-IP (Izlem Programi: Follow-up program) is the first AS registry in Turkey. Such databases are very useful and provide a basis for data collection from large numbers of subjects. TRASD-IP gives information on the clinical and demographic profiles of patients, and the efficacy and safety of anti-TNF drugs, examines the impact on quality of life, and provides real-life data that may be used in cost-effectiveness analyses. Wyeth/Pfizer CompanyWyeth The authors express their gratitude to all members of TRASD AS Study group for their cooperation and to Wyeth/Pfizer Company for the sponsorship. The authors declare that they have no conflict of interest.

Objectives: In this paper, we aim to present the new developments in the clinical findings and treatment of benign joint hypermobility syndrome [BJHS], in the light of recent studies, in an effort to give a better understanding and provide a review for the doctors involved.Findings: Hypermobility is a clinical sign independent of any rheumatic disease and is characterized by movement of joints beyond the normal range of motion. BJHS is associated with some system pathologies in which the main findings are correlated with the musculoskeletal system and can be easily confused with some hereditary and connective tissue disorders. Clinical signs of BJHS are considered in a range from joint instability to various problems, such as varicose veins and low bone mineral density.Conclusions: The clinical effects of BJHS are poorly understood by general practitioners and, furthermore, it may be misdiagnosed or neglected by rheumatologists too. For this reason, the clinical signs of this syndrome should be we...

Migraine attacks are characterized by headaches associated with neurological, gastrointestinal, and autonomic symptoms. A relationship between migraine and hypertension or hypotension is controversial. In this study, we aimed to determine if blood pressure changes were related to migraine attacks. From the outpatient clinic of our neurology department, 62 normotensive migraine patients with and without aura were chosen for study in accordance with the International Headache Society 2004 criteria. A questionnaire including general and specific questions was given to the patients to be filled out during 6 consequent migraine attacks. The patients received a fully automatic digital brachial upper arm sphygmomanometer (Omron M 4-1) to measure the changes in their blood pressure during attacks. The patients were asked to record their blood pressure changes 3 times: (1) just before or very early, (2) during (when headache peaks), and (3) 1 hour after the attack. Twenty-three of the 62 patients (57 women, 5 men) had migraine with aura (22 women and 1 man), and 39 of them did not have aura (35 women and 4 men). There was no statistically significant difference between systolic and diastolic values obtained before or very early, during the peak level, and 1 hour after the end of the attacks (P > 0.05). Although diastolic hypotensive values were not different statistically between groups, when all the patients were considered, diastolic hypotensive values were detected in a considerable number of patients (a total of 115 measurements). In this normotensive migrainous population, we observed that diastolic hypotension before or very early, during, and after migraine attack was the most significant result (5.1%). Although it was not statistically significant, the total number of hypotensive values was remarkable.

Resume Objectif Etudier l’importance de l’enthesite et sa correlation avec les parametres cliniques et la qualite de vie chez les patients atteints de spondylarthropathie (SA). Methode Cent dix-huit patients repondant aux criteres de classification du groupe europeen d’etude des spondylarthropathies (ESSG) ont ete inclus dans cette etude. Les parametres cliniques suivants ont ete evalues : la raideur matinale, les douleurs au repos, les douleurs au cours de l’activite physique et le nombre d’articulations gonflees et douloureuses. Les enthesites etaient evaluees par le Mander Enthesis Index (MEI). La qualite de vie etait mesuree par le questionnaire generaliste SF-36. Resultats L’incidence ainsi observee de l’enthesite chez les patients atteints de SA etait de 84 %. Une correlation significative etait retrouvee entre la raideur matinale, la duree de la maladie, les articulations douloureuses et six des dimensions du questionnaire SF-36. La plus importante correlation etait observee entre le MEI et le nombre d’articulations douloureuses (p Conclusion L’enthesite est couramment observee parmi les patients atteints de SA. Elle affecte negativement la qualite de vie des patients.

Objective To investigate the involvement of enthesis and its correlation with clinical and quality of life parameters in patients with spondyloarthritis (SpA). Methods One hundred and eighteen patients who comply with the SpA classification criteria of the European Spondylarthropathy Study Group (ESSG) were included into the study. Clinical parameters such as morning stiffness, rest pain, activity pain, tender joints and swollen joints were evaluated. Enthesitis were assessed by Mander Enthesis Index (MEI). The quality of life was assessed by Short Form-36 (SF-36). Results The incidence of enthesitis in patient with SpA was found at a rate of 84.9%. There was a significant correlation between MEI and morning stiffness, disease duration, tender joints and six subgroups of SF-36. The highest correlation was found between MEI and number of tender joint ( p Conclusion Enthesitis is commonly seen among patients with SpA. Enthesitis also affects the life quality of patients negatively.

WOS: 000282091400003, The purpose of this survey study was to determine the following: (a) What strategies do Turkish special education teachers use to address problem behaviors in their classroom? (b) What are teachers' views with regard to the effectiveness and acceptability of these strategies? (c) Is there a relationship between the use of strategies and teachers' perceived effectiveness and acceptability? and (d) Are differences among teacher ratings of strategy use, effectiveness, and acceptability associated with teacher characteristics (e. g., area of specialization, years of experience)? Results revealed that Turkish teachers' views of acceptability and effectiveness of strategies varied; however, in general, their ratings of positive strategies were higher than their ratings of reductive strategies. Results are discussed in the context of current literature, and directions for further research are suggested.

Resume Objectif Dans cette etude, nous avons l’intention d’etudier les taux seriques des enzymes antioxydantes et de l’oxyde nitrique (NO) chez les femmes postmenopausees atteintes d’osteoporose (OP) ainsi que chez des temoins sains et de determiner la relation entre ces enzymes, le NO et les parametres cliniques. Methode Quarante-cinq femmes postmenopausees remplissant les criteres diagnostic de l’OP de l’Organisation mondiale de la sante (OMS) et 42 femmes saines postmenauposees sans OP ont ete incluses dans cette etude. Les patientes de l’etude ont ete selectionnees parmi des femmes non prediagnostiquees ni pretraitees pour OP. Les patientes atteintes de maladies du metabolisme osseux, presentant des antecedents de fractures osseuses, fumeuses, consommatrices d’alcool et prenant des medications antioxydantes, etaient excluent de l’etude. Les resultats de l’absorptiometrie bioenergetique a rayons X (Dexa), l’indice de masse corporelle (IMC) et les donnees demographiques furent enregistrees. L’activite des enzymes catalase erythrocytaire (Cat) et glutathion reductase (GR), ainsi que le taux erythrocytaire en glutathion (GSH), le malondialdehyde plasmatique (MDA) etaient mesures par spectrophotometrie alors que les niveaux de nitrite/nitrate (NOx) etaient mesures par lecteur de microplaques Elisa. Resultats Les patientes avaient une activite enzymatique GR significativement plus basse (p Conclusion Le stress oxydatif peut jouer un role important dans la perte osseuse postmenopausique et par consequent il devrait etre pris en compte dans l’evaluation de la pathogenese de l’OP postmenopausique.

We aimed to investigate serum antioxidant enzymes and nitric oxide (NO) levels in postmenopausal women with osteoporosis (OP) and in healthy controls; and to determine the relationship between these enzymes, NO and clinical parameters in this present study.Forty-five postmenopausal women fulfilling OP diagnostic criteria of World Health Organization (WHO) and 42 postmenopausal healthy women without OP were enrolled. Patients in the study population were selected among individuals that were not pre-diagnosed or pre-treated for OP. Patients with metabolic bone diseases, fracture history, which were smokers, alcohol users and taking antioxidant drug treatment, were excluded from the study. Dual Energy X-ray Absorptiometry (DXA) results, body mass indices and demographic data were recorded. Erythrocyte catalases (CAT), glutathione reductase (GR) enzyme activities and erythrocyte glutathione (GSH) levels, plasma malondialdehyde (MDA) levels were measured by spectrophotometer whereas plasma nitrite+nitrate (NOx) levels were measured by ELISA microplate-reader.Patients had significantly lower GR (P0.01) enzyme activity and higher levels of MDA (P0.01) and NO (P0.01) than non osteoporotic healthy controls. There was no significant difference between both groups in erythrocyte GSH levels and CAT activities. Total femoral BMD measurements significantly correlated with MDA levels (P=0.001). There was no significant relationship between other antioxidants and lumbar or femoral BMD.Oxidative stress may play an important role in postmenopausal bone loss and therefore it might be considered when pathogenesis of postmenopausal OP has been investigated.

Dropped head syndrome is primarily based on weakness localized at neck extensors. It may result from motor neuron disease, myasthenia gravis, and chronic inflammatory demyelinating polyneuropathy and also from various neuromuscular diseases including inflammatory, dystrophic and metabolic myopathies. Camptocormia (CC) on the other hand is an unusual condition characterized by progressive weakness of the extensor vertebral muscles and results in involuntary trunk flexion. CC may emerge as a clinical feature of many different conditions such as several myopathies and Parkinson's disease. The association of dropped head syndrome with CC has been rarely published in the literature. However, this is the only case presenting with concomitant dropped head syndrome and CC as a clinical picture of myotonic dystrophy (MD). In this report we aimed to represent a female patient, who was diagnosed as having myotonic dystrophy, with concurrent dropped head syndrome and CC.

Resume Le syndrome de la tete tombante est lie principalement a une faiblesse des muscles extenseurs du cou. Cette faiblesse peut etre due a une maladie du motoneurone, a une myasthenie, a une polyneuropathie demyelinisante inflammatoire chronique ou a une maladie neuromusculaire, notamment a une myopathie inflammatoire, dystrophique ou metabolique. La camptocormie est un syndrome rare secondaire a une faiblesse progressive des extenseurs du rachis, qui est responsable d’une flexion involontaire du tronc vers l’avant. La camptocormie peut s’observer dans diverses pathologies, notamment certaines myopathies et la maladie de Parkinson. L’association d’un syndrome de la tete tombante et d’une camptocormie n’a ete que rarement rapportee. Nous decrivons le premier cas dans lequel cette association a pu etre rattachee a une myotonie.

We examined the association between serum trace elements and clinical findings such as number of sensitive tender points, severity of fatigue and functional status in patients with fibromyalgia (FM). Thirty-two patients diagnosed as having FM according to the ACR 1990 criteria and 32 normal healthy controls (NHC) were included in this study. The demographic data, disease duration, number of tender points and accompanying symptoms (fatigue, sleep disorders, headache, paresthesia, irritable bowel syndrome, sicca symptoms, Raynaud's phenomena) of the patients were noted. Visual analog scale (10 cm) was implemented to estimate daily severity of pain and fatigue. Fibromyalgia impact questionnaire was used for functional assessment. Serum selenium (microg/dL) and serum zinc (microg/dL) levels were measured by atomic absorption spectrometer. Serum magnesium (mmol/L) level was measured by the original kits of Abbott Aeroset auto-analyzer. The mean age of patients in FM group and NHC were calculated as 42.9 (SD = 7.7) years and 41.3 (SD = 9.7) years, respectively. Serum levels of zinc (P = 0.001) and magnesium (P = 0.002) were significantly decreased by FM groups, whereas there was no considerable difference with selenium levels of both groups (P0.05). Association between serum zinc level and number of tender points (P = 0.008) and that between fatigue and magnesium level (P = 0.003) was found as meaningful. According to the results of this study, it was asserted that serum magnesium and zinc levels may play an important role in the pathophysiology of FM.

Our aim in this study was to investigate serum hyaluronic acid (HA) levels and the relationship between clinical parameters in ankylosing spondylitis (AS). Approximately 30 patients with AS and 30 healthy individuals were recruited in this study consecutively. Cross-sectional study was planned, and demographic, clinical, functional, radiological, and laboratory data of patients were evaluated. Disease activity, functional status, and quality of life were assessed, respectively, with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Short-Form 36 (SF-36). Mander Enthesis Index (MEI) was used for evaluation of enthesis involvement. We examined serum concentrations of HA (ng/ml) in patients with AS and controls. The mean ages of patients and control group were 38.3 (SD = 10.8) and 42.7 (SD = 10.6) years, respectively. The mean of serum HA levels in AS patients was 40.4 (SD = 34.8) ng/ml and in controls was 24.9 (SD = 20.2). There was significant difference of HA levels between two groups (p = 0.04). Furthermore, there was a significant correlation between HA level and distance of hand–floor (r = 0.444, p = 0.014), modified lumbar Schober’s (r = −0.413, p = 0.023), distance of chin to chest (r = 0.436, p = 0.016), right sacroiliit grade (r = 0.601, p

We examined the association between clinical parameters of disease activity and serum hyaluronic acid (HA) level in patients with knee osteoarthritis (OA). Fifty-eight patients with knee OA and 40 healthy individuals were included in this study. Demographic data were noted. The radiological evaluation was done according to Kellgren/Lawrence Grading System. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used in evaluating the clinical disability caused by OA. Erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) level were determined in laboratory evaluations. Serum HA levels (in nanogram per milliliter) of both groups were measured by enzyme-linked immunosorbent assay. The mean ages of patients in OA group and control group were 57.58 (9.55) and 43.3(10.2) years, respectively. There was a significant difference between HA levels of both groups (p=0.02). Also, there was a significant correlation between HA level and disease duration (p=0.04), ESR (p=0.001), and CRP level (p0.001). However, there was no significant correlation between HA levels with WOMAC and radiological grade (p0.05). There is no satisfactory amount of data regarding HA level in OA. In our study, we demonstrated that HA was in high levels in the serum of patients with OA. We suggest that serum HA levels may be used as a marker to determine the disease activity.

This study used structured analogue situations to examine factors that might influence teachers' preferences and opinions about language interventions. These factors included respondent groups (preschool vs. elementary school teachers), type of treatment approach (naturalistic vs. therapeutic), person delivering the intervention (classroom teacher vs. speech and language pathologist [SLP]), and severity of language delay (mild vs. severe). Sixty-six teachers (28 elementary and 38 preschool teachers) participated in this survey study. Results showed that preschool teachers found naturalistic approaches slightly more acceptable than the therapeutic approach, whereas elementary school teachers viewed the therapeutic approach as somewhat more acceptable than naturalistic approaches. Teachers rated three intervention approaches differently when they were applied to children with mild versus severe language delays. Implications for research and practice of these findings are discussed.

IntroductionAnkylosing spondylitis (AS) is a chronic, inflammatory rheumatic disease characterized by the inflammation of the pelvis and spine that results in a restriction in the mobility of the spine. Due to the altered posture and nocturnal inflammatory pain, sleep disturbances are likely to occur in patients with AS.ObjectiveThis cross-sectional study aimed at determining the differences between the patients with AS and healthy controls in sleep quality, as well as assessing the relationship between the sleep quality and disease activity.MethodIn order to assess sleep quality, fifty-five patients with AS (40 men, 15 women; mean age, 43±1 years) who fulfilled the modified New York criteria and fifty-five comparable controls (40 men, 15 women; mean age, 42±9 years) completed the Pittsburgh Sleep Quality Index (PSQI) questionnaire. The disease activity was assessed by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI).ResultsAnkylosing spondylitis was associated with a significantly impaired sleep quality according to the total PSQI scores (p=0.001). Significant differences were found between the patients with AS and healthy controls in PSQI domains, including “subjective sleep quality” (p=0.010), “sleep duration” (p=0.011), “habitual sleep efficiency” (p=0.034), “sleep disturbances” (p=0.003) and “daytime dysfunction” (p=0.009) but not in “sleep latency”, “use of sleep medication”. There was a significant positive correlation between the BASDAI and PSQI scores (r=0.612, p=0.001).ConclusionIn the current study, we found that the sleep disturbances were significantly higher in patients with AS in comparison to controls. Patients with active disease had worse sleep quality. In addition, disease activity was correlated with the scores of most of the PSQI subscales. Sleep quality assessment should be a tool for evaluating patients with AS.

The Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire is a disease-specific measure of needs-based quality of life developed in the UK and the Netherlands. This study describes translation, validation, and reliability of the scale into Turkish population. The ASQoL was translated into Turkish using the dual-panel process. Content validity was assessed via cognitive debriefing interviews with ankylosing spondylitis (AS) patients. Patients with AS according to modified New York criteria were recruited into the study from 12 hospitals of all part of Turkey. Psychometric and scaling properties were assessed via a two administration survey involving the ASQoL, the Nottingham Health Profile (NHP), Bath AS Functional Index (BASFI), and Bath AS Disease Activity Index (BASDAI). Classical psychometrics assessed reliability, convergent validity (correlation of ASQoL with NHP, BASFI, and BASDAI) and discriminative validity (correlation of ASQoL with perceived AS-severity and general health). Cognitive debriefing showed the new Turkish ASQoL to be clear, relevant, and comprehensive. Completed survey questionnaires were received from 277 AS patients (80 % Male, mean age 42.2/SD 11.6, mean AS duration 9.4 years/SD 9.4). Test-retest reliability was excellent (0.96), indicating low random measurement error for the scale. Correlations of ASQoL with NHP sections were low to moderate (NHP Sleep 0.34; NHP Emotional Reactions 0.83) suggesting the measures assess related but distinct constructs. The measure was able to discriminate between patients based on their perceived disease severity (p < 0.0001) and self-reported general health (p < 0.0001). The Turkish version of ASQoL has good reliability and validity properties. It is practical and useful scale to assess the quality of life in AS patients in Turkish population.