Objectives: This study aims to explore the accordance to the 2018 European League Against Rheumatism (EULAR) recommendations forthe management of hand osteoarthritis (OA) among the Turkish League Against Rheumatism (TLAR) expert panel and composition of TLARrecommendations for the management of hand OA under guidance of the current literature.Materials and methods: The TLAR convener designated an expert panel of 10 physicians experienced in hand OA for this process. The 2018 EULARrecommendations for the management of hand OA and the systematic review of the literature were sent to the expert panel via e-mails. The e-mailprocess which included Delphi round surveys was completed. The EULAR standard operational procedure Appraisal of Guidelines for Researchand Evaluation II was followed. The level of agreement was calculated for each item and presented as mean, standard deviations, minimum andmaximum and comparisons of 2018 EULAR recommendations were performed.Results: Five overarching principles and 10 recommendations were discussed. Revisions were held for the sixth, seventh, and ninth recommendationswith lowest level of agreements. These recommendations were revised in accordance with suggestions from the experts and re-voted. The revisedforms were approved despite the lack of statistically significant difference between these forms (p=0.400, p=0.451, p=0.496, respectively). Exceptfor the ninth recommendation about surgery (p=0.008), no significant difference in level of agreements was observed between the EULAR and TLARhand OA recommendations. The 11th recommendation about paraffin bath was added.Conclusion: The optimal treatment of hand OA consists of personalized non-pharmacological (self-management, exercise, splint), pharmacological(topical non-steroidal anti-inflammatory drugs as the first choice), and interventional procedures (only for refractory cases) based on shared decisionbetween the patient and physician. TLAR hand OA recommendations were created mainly based on the most recent literature and the last EULARhand OA management recommendations, which are widely approved among the TLAR experts.
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Objectives: This study aims to determine the preferences of physical and rehabilitation medicine (PRM) residents in Turkey for future career choices,subspecialty training plans, and practice location and to identify the factors that influence those preferences.Materials and methods: Using a cross-sectional study design, a survey was sent to all PRM residents enrolled in the Turkish Society of PhysicalMedicine and Rehabilitation and the Turkish League Against Rheumatism (n=500). A total of 181 residents (36%) (74 males, 107 females; meanage 28.8 years; range 24 to 40 years) responded to the survey. Data were collected about demographic profile of respondents and PRM clinics,respondents’ experiences in rheumatology education and injection skills, preferences for fellowship training, and future practice location.Results: Thirty-five percent of residents intended to pursue fellowship training. Rheumatology was more preferred than algology. Male sex waspositively associated with the decision to pursue fellowship training and also having an algology division in the PRM department was positivelyassociated with planning to pursue algology fellowship training. For those planning to pursue fellowship training, the most influential factors wereprestige, interest in an academic career and the possibility of performing compulsory service in a better location. Thirty-four percent of residentspreferred to work in university hospitals after residency while 57% of residents who planned to pursue fellowship training preferred to practice atuniversity hospitals after their fellowship. Thus, an academically oriented career was the most desirable career choice.Conclusion: One-third of residents training in Turkey chose to pursue fellowship training and work in university hospitals. Performing compulsoryservice was the top factor affecting the decisions of both undecided and reluctant residents; thus, career plans of PRM residents in Turkey are notbased solely on personal and professional desires, but require consideration of compulsory service.
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OBJECTIVE: To determine the validity and reliability of the Turkish version of the Trunk impairment scale (TIS), used in theevaluation of somatic, motor, and coordination disturbances in stroke patients, and provide a culturally adapted version foruse in the Turkish population.METHODS: A total of 80 patients who were either hospitalized at our facility and rehabilitated for stroke or admitted at ouroutpatient clinics were included in this study. Reliability was evaluated by the internal consistency (Cronbach α) and testreproducibility [intra-class correlation coefficient (ICCC)] methods, and validity was evaluated by the correlation betweensubgroups and the total scores of the TIS and Berg Balance Scale (BBS), Brunnstrom phases, Barthel index (BI), Rivermeadmobility index (RMI), and Short Form-36 (SF-36) scores.RESULTS: The mean age of the patients was 63.00±12.1 years. Out of a total of 80 subjects, 34 were female and 46 weremale. The reliability of the scale was evaluated by the internal consistency, inter- and intra-observer reliability, and test reproducibility. The findings showed that the Turkish form of the scale was reliable at a good level. The test values were as follows;Cronbach α: >0.70, ICCC: 0.969–1, subgroups and total score comparison: 0. The correlation between TIS and BBS wasconsiderably high in the validity analysis (p<0.001). Further, significant associations among the BI, RMI, KF-36, Brunnstrom,and TIS scores were found (p<0.001), which indicate the structural validity of this scale.CONCLUSION: TIS is a scale used in measuring the motor derangement that develops after a stroke. It has sufficient reliability, internal consistency, and validity for use in clinical practice and stroke investigations. Our study has shown that TISused for the evaluation of body balance is valid and reliable for the Turkish population.
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Selda ÇİFTCİ,
KADRİYE BANU KURAN , Zehra DUMAN, Figen YILMAZ, Cansu MERT, Gülgün DURLANIK, Jülide ÖNCÜ, Bilge DÜDEN, Hüseyin BERTAN,
CEM ERÇALIK ,
BERİL DOĞU , Rana TERLEMEZ
Stroke and Parkinson's disease are 2 major causes of movement impairment and a decreased ability to perform daily activities. The aim of this case series was to demonstrate the difficulty of rehabilitation in stroke patients with accompanying parkinsonism. Four stroke patients with parkinsonism who underwent rehabilitation at the Physical Medicine and Rehabilitation Clinic between March and May of 2016 were evaluated. The Standardized Mini-Mental State Examination (SMMSE), the Functional Independence Measure (FIM), the Barthel Index (BI), the Berg Balance Scale (BBS), and the Stroke Impact Scale version 3.0 (SIS) were used in the assessment. Of the 4 patients, 3 were female, and the mean age was 74.5±9.3 years. The mean hospital stay was 19±5.3 days. The initial test scores recorded were low, and they remained low at the time of discharge. After rehabilitation, the mean FIM score in the group was 42% of the maximum possible score, the mean SMMSE was 55%, the BI was 18%, the BBS was 0.08%, and the SIS was 25%. Three patients required a wheelchair, and 1 patient could ambulate with a walker at discharge. A stroke accompanied by parkinsonism negatively affects mobility and functional status, primarily through the deterioration of balance. In this study, cognitive function was reduced to half of the maximum, and the balance and function loss was more than 50%. Barthel index; berg balance scale; functional independence measure; mini-mental state examination; parkinsonism; stroke; stroke impact scale.
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TİRAJE TUNCER , Erdal GİLGİL,
CAHİT KAÇAR , Yeşim KURTAİŞ,
ŞEHİM KUTLAY , Bülent BÜTÜN, Peyman YALÇIN,
ZEYNEP ÜLKÜ AKARIRMAK ,
LALE ALTAN İNCEOĞLU ,
FÜSUN ARDIÇ , Özge ARDIÇOĞLU,
ZÜHAL ALTAY , Ferhan CANTÜRK,
AYŞE BEYHAN LALE CERRAHOĞLU ,
REMZİ ÇEVİK ,
HÜSEYİN DEMİR ,
BERRİN DURMAZ ,
NİGAR DURSUN ,
MEHMET TUNCAY DURUÖZ , Canan ERDOĞAN, Deniz EVCİK,
SAVAŞ GÜRSOY ,
SAMİ HİZMETLİ , Ece KAPTANOĞLU, Önder KAYHAN,
MEHMET KIRNAP , Siranuş KOKİNO,
MUSTAFA ERKAN KOZANOĞLU ,
KADRİYE BANU KURAN ,
KEMAL NAS , Sema ÖNCEL,
DİLŞAD SİNDEL , Sevim ORKUN,
TUNAY SARPEL ,
SERPİL SAVAŞ ,
ÖMER FARUK ŞENDUR , Kazım ŞENEL,
HATİCE UĞURLU , Kaan UZUNCA,
İBRAHİM TEKEOĞLU , Francis GUILLEMIN
Objectives: This study aims to estimate the prevalence of rheumatoid arthritis (RA) and spondyloarthritis (SpA) in Turkey using the same telephone questionnaire developed for screening RA and SpA in France and used in Serbia and Lithuania. Material and methods: The study was performed in two steps. In step I, the French questionnaire was translated into Turkish and validated through a group of 200 patients (80 males, 120 females; mean age 44.0±13.1 years; range, 19 to 75 years) followed up at the rheumatology departments of University Hospitals in Antalya and Ankara. In step II, the validated Turkish questionnaire was administered face-to-face to randomly selected 4,012 subjects (1,670 males, 2,342 females; mean age 41.5±16.8 years; range, 16 to 97 years) by trained general practitioners across the country, in 25 provinces for case detection. The subjects who were suspected of having RA or SpA in accordance with the questionnaire were invited to the nearest university hospital for rheumatologic examination in order to confirm the diagnosis. Results: In step II, a total of 25 subjects (2 males, 23 females) were diagnosed as RA. The standardized RA prevalence for the general population of Turkey was calculated as 0.56% (95% confidence interval [CI]; 0.33-0.79), 0.10% (95% CI; -0.05-0.25) for males and 0.89% (95% CI; 0.51-1.27) for females. A total of 18 subjects (3 males, 15 females) were diagnosed as SpA. The standardized SpA prevalence for the general population of Turkey was 0.46% (95% CI; 0.25-0.67), 0.17% (95% CI; -0.03-0.37) for males and 0.65% (95% CI; 0.32-0.98) for females. The prevalence of RA was highest in the Northern region (2.00%) and the prevalence of SpA was highest in the Central region (1.49%). Conclusion: The prevalences of RA and SpA in Turkey are close to each other and there are significant inter-regional variations in prevalences of both RA and SpA.
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Encephalitis is an acute inflammation of the central nervous system that is characterized by fever, headache, and sleep disorders. Among the causes of meningoencephalitis are bacterial and viral infections, autoimmune diseases, and drug reactions. This case report describes a male patient who experienced hemiplegia following encephalitis. A 35-year-old patient consulted a physician with complaints of fever and headache. The clinical evaluation was encephalitis and the patient was treated accordingly. A severe neurological deficit developed, and the patient became bedridden, After treatment, the patient was included in an inpatient physical therapy program and was subsequently discharged with the ability to walk using parallel bars. The aim of this case report was to draw attention to the rehabilitation process applied after the diagnosis and treatment of a patient with hemiplegia that developed as a complication of encephalitis.
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Morel-Lavallée lesion is an unusual clinical entity which was first described by the French surgeon Maurice Morel-Lavallée in 1853. Theselesions result from peeling off the surfaces between the fat tissue and the muscular fascia. During this decomposition, the rupture of smallvessels may cause an effusion full of necrotic blood, lymph and fat cells. In prolonged cases, these lesions may become increasingly painful,leading to be confused with other diagnosis such as sciatalgia, piriformis syndrome, trochanteric bursitis or soft tissue tumor. Herein, wepresent a-65-year-old female case who had pain in the right thigh for one year and was referred to our clinic with radicular pain.
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Schwannomlar ‘nörilemma’ olarak da adlandırılan schwann hücrelerinden kaynaklanan periferik sinirlerin en sık görülen benigntümörüdür. Sıklıkla baş ve boyun bölgesinden kaynaklanan soliter lezyonlardır. Tanı esasında ultrasonografi, manyetikrezonans görüntüleme ve histopatolojik incelemelere dayanır. Kapsüllü olduğundan dolayı cerrahi eksizyon sonrasında nüksihtimali düşüktür ve iyi bir prognoza sahiptir. Bu yazıda, ilk bakışta ganglion kistini taklit eden bir schwannom olgusu sunuldu.
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Selda ÇİFTCİ, Jülide ÖNCÜ ALPTEKİN, Zehra DUMAN, Cansu MERT, Rana TERLEMEZ, Figen YILMAZ,
KADRİYE BANU KURAN
Selda ÇİFTCİ, Jülide ÖNCÜ ALPTEKİN, Zehra DUMAN, Cansu MERT, Rana TERLEMEZ, Figen YILMAZ,
... Devamını oku
Glukokortikoid kullanımı sırasında pek çok yan etkiyle karşılaşılmaktadır. Osteoporoz kemik metabolizması üzeri sık görülen yan etkisidir. Yüksek dozda ve uzun süreli steroid kullanımı sırasında yan etki artar. Bu yazımızda, Behçet hastalığına bağlı göz tutulumu nedeniyle yaklaşık 6 yıldır kontrolsüz glukokortikoid ve 3 yıldır siklosporin kullanımı sonucu dorsal ve lomber vertebralarda osteoporotik fraktür gelişen genç erkek bir olgu sunulmuştur. Sonuç olarak bu olgu, steroidlerin ve kombinasyon tedavilerinin gerekli endikasyonlarda, uygun doz ve süreyle kullanılmasını, hastaların düzenli takip edilmelerinin gerektiğini göstermiştir
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Topuk ağrısı ayak ağrılarının %15'ini oluşturur. Ağrı, plantar fasiit, kalkaneal kırık, kalkaneal apofizit, topuk yastığının atrofisi, enflamatuar hastalıklar gibi nedenlere bağlı olabildiği gibi sinir kökenli de olabilir. Tibial, plantar ve/veya medial kalkaneal sinir sıkışması ağrının nöral nedenlerindendir. Medial kalkaneal sinir topuktaki yumuşak dokuların çoğunun duysal innervasyonunu sağlar. Topuk ağrısının nöral kaynaklı olduğunu teşhis etmek için öykü ve dikkatli bir fizik muayene gerekir. Topuk ağrısının diğer nedenleri dışlanmadan önce cerrahi girişim için acele edilmemeli, konservatif tedavi sonrasında tanı yeniden gözden geçirilmelidir.
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