Amaç: Kronik ağrılı hastalarda vitamin D düzeyi ile anksiyete ve depresyon arasındaki ilişkiyi belirlemektir.Gereç ve Yöntem: Çalışmaya 160 hasta (125 kadın, 35 erkek) alındı. Çalışmaya 18 yaş üstü çalışma sorularını cevaplayabilecek düzeyde olankadın ve erkek hastalar dahil edildi. Hastaların yaş, cinsiyet, boy, kilo, hastalık süresi, tanı, komorbid durumları kaydedildi. Vücut kitle indeksi(VKİ) (kg/m2) hesaplandı. Vizüel analog skala (VAS) (0-10) ile ağrı değerlendirildi. Hastane anksiyete ve depresyon ölçeği (HAD) hesaplandı.Çalışmaya dahil edilen hastalar vitamin D düzeyine göre iki gruba ayrıldı (grup 1 vitamin D: 0-19, grup 2 vitamin D: 20-60 ng/mL). Ayrıcavitamin D düzeyleri kaydedildi.Bulgular: Çalışmaya dahil edilen hastaların yaşı 58,72±8,21 yıl olarak hesaplandı. Vitamin D eksikliği %42,8 olarak saptandı. Vitamin D eksikliğikadınlarda %80,7 olarak belirlendi. Kronik ağrılı hastalarda vitamin D düzeyi ile yaş (r=0,185, p=0,026), VKİ (r=0,084, p=0,316), hastalık süresi(r=0,067, p=0,420), VAS (r=0,038, p=0,648), HAD anksiyete (r=0,020, p=0,808) ve HAD depresyon (r=0,048, p=0,569) arasında korelasyontespit edilmedi. Kronik ağrılı hastalarda VKİ ile vitamin D düzeyi arasında (r=-0,117, p=0,165) ilişki tespit edilmezken, VKİ ile VAS (r=0,305,p=0,000), HAD anksiyete (r=0,185, p=0,001) ve HAD depresyon (r=0,0240, p=0,002) arasında pozitif korelasyon saptanmıştır.Sonuç: Çalışmamızda kronik ağrılı hastalarda vitamin D düzeyi ile anksiyete ve depresyon arasında ilişki tespit etmedik. Ancak, obezite ileağrı şiddeti arasında korelasyon saptadık. Ayrıca obezitenin anksiyete ve depresyonla ilişkili olduğunu tespit ettik. Kronik ağrı tedavisindekilo verilmesi gibi yaşam tarzı değişikliklerinin uygulanması ve vitamin D eksikliğinin replasmanı anksiyete ve depresyon durumunda iyileşmesağlayabilir.
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Objective: To investigate level of kinesiophobia and related factors in postmenopausal women with osteoporosis (OP) and osteopenia (OPN).Materials and Methods: A total of 60 female patients with postmenopausal OP, 60 female patients with postmenopausal OPN and60 age- and gender-matched controls were enrolled in this study. Demographic data (age, weight, height, body mass index, educationallevel, employment status, disease duration and menopause duration) of the participants were recorded. In all participants, the level ofkinesiophobia, fear of falling, psychological status, health-related quality of life and osteoporosis self-efficacy were evaluated using the Tampascale of kinesiophobia (TSK), falls efficacy scale-international (FES-I), hospital anxiety and depression scale (HADS), quality of life questionnaireof the European Foundation for Osteoporosis-41 (QUALEFFO-41) and osteoporosis self-efficacy scale (OSES), respectively.Results: Postmenopausal patients with OP and OPN had higher levels of kinesiophobia than controls (p<0.05). However, there was nodifference between the levels of kinesophobia in patients with OP and OPN (p>0.05). In addition, a positive correlation was found betweenTSK score and FES-I, HADS, QUALEFFO-41 scores and duration of menopause, and a negative correlation between OSES scores in patientswith OP and OPN (p<0.05). Patients were divided into two groups according to their kinesiophobia levels: High and low kinesiophobia groups.All clinical parameters were negatively affected in patients in the high kinesophobia group (p<0.05).Conclusion: Both OP and OPN may cause kinesiophobia in postmenopausal women. Increased fear of falling, impaired psychological status,poor quality of life, decreased perception of self-efficacy and prolonged duration of menopause in postmenopausal women with OP and OPNseem to be associated with a higher level of kinesiophobia. As physical activity is essential for bone health, postmenopausal women with OPand OPN should be counselled about the importance of overcoming kinesiophobia
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Objective: The relationship between bone mineral density (BMD) values and nutritional status as well as serum copper (Cu), zinc (Zn),selenium (Se) and manganese (Mn) levels in postmenopausal women has not been fully elucidated. Therefore, this study aimed to investigatewhether there is a relationship between BMD values and nutritional status as well as serum Cu, Zn, Se and Mn levels by evaluating thenutritional status of postmenopausal women based on the BMD values using an objective index.Materials and Methods: The study included 105 postmenopausal women who were divided into the following 3 groups: Controls (controlgroup, n=30, T-score >-1.0), patients with osteopaenia (osteopaenia group, n=30, T-score >-2.5) and patients with osteoporosis (osteoporosisgroup, n=45, T-score ≤-2.5). Moreover, the nutritional status of the patients was determined using the prognostic nutritional index (PNI), whichis calculated based on the serum albumin levels and total lymphocyte count. Further, serum Cu, Zn, Se and Mn levels were also determined.The relationship between BMD and PNI as well as the serum levels of Cu, Zn, Se and Mn was investigated.Results: The mean age and body mass index (BMI) of the participants were found to be similar in all the groups [control group (age, 63.4±5.2years; BMI, 33.7±5.6 kg/m2); osteopaenia group (age, 64.6±5.3 years; BMI, 33.5±5.9 kg/m2) and osteoporosis group (age, 65.8±5 years;BMI, 30.9±7.2 kg/m2)]. In the osteoporosis group, the PNI and serum albumin, Cu and Zn levels were significantly lower than those in thecontrol group (p<0.05), and a weak positive correlation was observed between lumbar total BMD values and PNI as well as serum albuminand Mn levels (p<0.05). Furthermore, a positive moderate correlation between PNI and serum Zn levels was observed in the osteoporosisgroup (p=0.045, r=0.063).Conclusion: Low serum albumin levels and a low PNI, particularly in postmenopausal patients with osteoporosis, may have an adverse effecton the total BMD in the lumbar region. Furthermore, Zn supplementation in patients with osteoporosis having low PNI can be a potentialadditional treatment strategy. Cu and Mn supplementation may also provide an additional benefit to existing treatments.
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Objective: Vertebral fractures impair the quality of life in the geriatric patients and increase their economic costs. In this study, we aimed toidentify spontaneous vertebral fracture rates and associated risk factors in the elderly.Materials and Methods: Patients over the age of 65 years who were admitted to our physical medicine and rehabilitation outpatient clinicwith back pain between January 2018 and June 2018 were examined retrospectively. A total of 136 patients with thoracic and lumbar spinefractures were included in this study. Data regarding osteoporosis treatment, diabetes mellitus, chronic renal failure and thyroid dysfunctionsas well as vitamin D levels were recorded for all patients.Results: The mean age of the patients (female/male: 119/17) was 73.9±6.6 years. Spontaneous vertebral fractures were detected in 74patients (54.4%). Vertebral fractures were concentrated in the lower thoracic and upper lumbar regions. The patients were divided into thefollowing two groups: Group 1 (65-74 years old) and group 2 (≥75 years old). Moreover, the rate of vertebral fracture was significantly higherin group 2 than in group 1 (p˂0.05). Regression analysis revealed that age, female gender and the presence of osteoporosis were associatedwith vertebral fractures.Conclusion: Vertebral fractures increase dramatically in geriatric patients. Furthermore, advanced age is an independent risk factor forvertebral fractures. Due to the high diagnostic and treatment costs as well as negative impacts of vertebral fractures on the quality of life, itsdiagnosis and treatment must be performed in a timely manner for the geriatric patients.
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Sarkoidoz, non-kazeifiye granülomlarla karakterize, başta akciğerler olmak üzere, pek çok doku ve organı etkileyebilen bir hastalıktır. Sarkoidozda,granülomların direkt etkisi, makrofajlardan salınan 1,25-dihidroksivitamin D gibi osteoklast aktive edici faktörler ve glukokortikoidlerin kullanımıile osteopeni, osteoporoz ve patolojik kemik kırıkları görülebilir. Sarkoidozun kemik tutulumu, el ve ayakta tipik kistik yapılar meydana getirir.Vertebral tutulum ise nadirdir ve litik, sklerotik veya mikst lezyonlara neden olabilir. Metastatik lezyonlar ile ayırıcı tanı yapılmalıdır.
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Cystic fibrosis is a common genetic disease of the white population with autosomal recessive inheritance. It may present with sinopulmonary,gastrointestinal, genitourinary, bone and joint findings. Osteoporosis, osteopenia, and fractures are musculoskeletal problems related to thedisease. Although vertebral fractures are common, non-vertebral fractures have been reported rarely. In this case report, we present the caseof a 9-year-old girl with osteopenia-induced femoral neck stress fracture caused by cystic fibrosis. During hospitalization for sinopulmonaryinfection, the patient presented to our clinic with left thigh pain without trauma. The left hip joint was examined and found to be clear.Anterior posterior X-ray examination of the patient, who had difficulty in stepping, revealed no displaced fracture. The patient was laterdiagnosed with type 2 Fullerton & Snowdy fracture, and surgical fixation was ruled out. The patient was successfully treated with non-steroidalanti-inflammatory drugs and immobilization.
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Stres kırıkları kemiklerin tekrarlayıcı ve mekanik olarak aşırı yüklenmelerine bağlı olarak oluşurlar. Yorgunluk ve yetersizlik kırıkları olmaküzere iki alt tipi vardır. Genellikle etkilenen kemikte ağrı hareketle artar ve istirahatle azalır. Sıklıkla tibia, pelvis kemikleri ve ayak kemiklerindegörülürler. Erken dönemde direkt grafi genellikle normaldir. Dikkatli anamnez, fizik muayene ve ileri görüntüleme yöntemleri ile tanı koyulur.Günlük pratiğimizde sıklıkla gözden kaçabilen, tanı konulması zor olan stres kırıkları klinik şüphe varlığında ayırıcı tanıda mutlaka düşünülmelidir.Bu makalede farklı anatomik bölgelerde stres kırığı olan 3 hasta sunulmuştur.
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Objective: Behçet’s disease (BD) is a multisystemic inflammatory disease that causes significant morbidity worldwide. In this study, we aimed to evaluate the clinical and demographic characteristics of the patients with BD.Materials and Methods: Patients admitted to our physical medicine and rehabilitation clinic between January 2015 and December 2018 were evaluated retrospectively. One hundred sixty patients who met the diagnostic criteria of the International Study Group for BD were included in the study. In addition to the patients’ demographic characteristics, their clinical features, including age at onset, symptoms on initial admission, disease duration, systemic/organ involvement and medical treatments used, were recorded.Results: The mean age of the 160 patients included in the study was 40.48±10.0 [minimum (min): 19, maximum (max): 72]. The mean age at disease onset was 30.54±8.46 (min: 14, max: 62). The most common involvement type in BD was mucocutaneous manifestations, and oral aphthae were the most common mucocutaneous symptom, with an occurrence rate of 100%. Regarding clinical manifestations, 36.3% (n=58) of patients showed ocular involvement, 16.9% (n=27) had vascular involvement and 15% (n=24) had musculoskeletal involvement. The rarest involvement was that of the genitourinary system, with a rate of 0.6% (n=1). Colchicine was the most commonly used therapeutic agent, whereas steroids, azathioprine, cyclosporine and various biologicals could also be used, depending on clinical status.Conclusion: The results of our study suggest that, although the most common manifestation of BD is mucocutaneous involvement, the involvements of various systems, such as the ocular, musculoskeletal and neurological systems, are not rare and are associated with severe morbidity and mortality. Treatment modalities vary according to the systems and organs involved. Therefore, it is very important to systematically evaluate patients with BD and to arrange appropriate and effective treatment
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Yunus ÖÇ,
Bekir Eray KILINÇ , Onur GÜLTEKİN, Ethem Aytaç YAZAR, Ali VAROL, Hacı Mustafa ÖZDEMİR
Yunus ÖÇ,
Bekir Eray KILINÇ ,
Onur GÜLTEKİN, Ethem Aytaç YAZAR, Ali VAROL, Hacı Mustafa ÖZDEMİR
Objective: This study aimed a better diagnosis for patients with primary hyperparathyroidism (PHPT), who could be referred to misdiagnosis and treatment and be able to demonstrate a well analysis of patient before orthopaedic surgery.Materials and Methods: A total of 12 patients admitted to our orthopaedics outpatient clinic between 2003 and 2017, examined and treated due to the bone lesion or fracture and diagnosed with PHPT, were included in this study. Patients were referred to the general surgery clinic for adenectomy. Direct radiograph was used to follow cysts recession after adenectomy.Results: Patients have the mean age of 36.6±13.4 years, wherein seven were female and five were male. Individual bone involvement was observed in three patients, whereas nine patients had multiple bone involvement. Eight patients had pathological fractures. Biopsy was conducted on all patients, revealing an increased osteoclastic activity and multinuclear giant cells, and a report was issued for these findings.Conclusion: Brown tumor is very rare reactive lesions developed in bone tissues during hyperparathyroidism. In order to make a definitive diagnosis for the cystic and lytic lesions, suspecting the patient’s clinical status and keeping any possible diagnosis in mind is necessary.
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Objective: The incidence of osteoporosis increased in patients with chronic obstructive pulmonary disease (COPD), and fractures due to osteoporosis are a significant cause of morbidity. Thus, risk assessment and taking necessary precautions are essential in these patients. This study aimed to assess the fracture risk of patients with COPD scanned with dual-energy X-ray absorptiometry (DXA) using the fracture risk assessment tool (FRAX) and to identify their treatment status.Materials and Methods: Patients who presented to the Physical Therapy Outpatient Clinic of Aydın Atatürk State Hospital and diagnosed with COPD between January 2014 and January 2019 were included in the study. Results of DXA and pulmonary function test performed within the last year were recorded. According to the DXA results, patients were divided into osteoporotic, osteopaenic and normal groups. Patients were also classified into group A, B, C and D according to the Global Initiative for Chronic Obstructive Lung Disease classification. FRAX values were calculated using an online calculator.Results: Ninety-five patients with COPD were enrolled in the study. According to their DXA values, 39 (41.1%), 41 (43.2%) and 15 (15.8%) patients were allocated in the osteoporotic, osteopaenic and normal groups, respectively. The 10-year major osteoporotic and hip fracture risks, calculated using FRAX, was the highest in the osteoporotic group, followed by the osteopaenic group (p<0.001 and p<0.001, respectively). Thirty-six patients (92.3%) in the osteoporotic group received medical treatment for osteoporosis, whereas only 13 (31.7%) patients in the osteopaenic group received medical treatment. FRAX assessment revealed that both major osteoporotic and hip fracture risks were higher in groups C and D (p=0.002 and p=0.002, respectively).Conclusion: All patients with COPD, particularly those in groups C and D, should be assessed with both DXA and FRAX, regarding osteoporosis and fracture risks, and preventive measures/treatment should be planned when required.
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