Biomedical subjects
Publications and source records attributed to Hatice Bodur.
Hysterical paralysis is an uncommon type of conversion disorder. It can be difficult to diagnose. In cases in which symptoms are difficult to explain neuroanatomically or are functionally inconsistent, hysteria should enter into the differential diagnosis. We report a case of hysterical paralysis that had rapid improvement using physical therapy and antidepressant therapy.
The aim of this study was to determine the peripheral nerve involvement electrophysiologically in Behçet patients without clinically evident neurological signs and symptoms. Sixty-three patients who fulfilled the International Study Group Classification Criteria for Behçet's disease (BD) and 49 healthy control subjects were enrolled to the study. Conventional electrophysiological studies of peripheral nerves including F latencies were performed to all subjects. Thirty-one male and 32 female Behçet patients with a mean age of 33.6+/-11.1 years and (22 male and 27 female healthy control subjects with a mean age of 35.8+/-9.9 years were included to the study. All but four of the patients were active. In the BD group, electrophysiologically diagnosed neuropathy was detected in nine (14.28%) patients. One (1.58%) patient had sensorimotor polyneuropathy, one patient (1.58%) had sural and ulnar sensorimotor neuropathy, three (4.75%) patients had median and one patient (1.58%) had ulnar sensorimotor neuropathy. Sural nerve sensorial action potential was unobtainable in two (3.17%) patients and prolonged F latencies were observed in two (3.17%) patients. In the control group only one subject (2.4%) had low sural sensorial conduction velocity. The frequency of neuropathy was higher in the patients with BD when compared with the control subjects. Sensory nerves were affected more prominently than motor nerves. There was no relationship between the clinical and laboratory characteristics of the patients and the electrophysiologic findings. No significant difference was observed between the clinical parameters of the patients with and without electrophysiologically detected neuropathy, except the levels of disease duration (8.8+/-5.1 vs 5.28+/-4.3 years, respectively, p<0.05). In conclusion, Behçet patients may have subclinical peripheral nerve involvement. Conventional electrophysiologic nerve conduction studies including F responses are recommended in routine examination to diagnose early neuropathy in Behçet patients without evident neurologic symptoms.
The objective of this study was to compare the short- and long-term efficacies of splinting (S), splinting plus local steroid injection (SLSI), and open carpal tunnel release (OCTR) in mild or moderate idiopathic carpal tunnel syndrome (CTS). Patients with mild or moderate idiopathic CTS who experienced symptoms for over 6 months were included in the study. The patients were evaluated for the baseline and the third and sixth month scores after treatment. Follow-up criteria were ENMG parameters, Boston Questionnaire, and patient satisfaction. Fifty-seven hands completed the study. Twenty-three hands had been splinted for 3 months. Twenty-three hands were given a single steroid injection and splinted for 3 months, and 11 hands were operated. In the first 3 months, all treatment methods provided significant improvements in both clinical and EMG parameters in which OCTR had better outcomes on median sensorial nerve velocity at palm wrist segment. In the second 3 months, while the clinical and EMG parameters began to deteriorate in S and SLSI group, OCTR group continued to improve, and BQ functional capacity score of OCTR group was statistically better than that in conservative methods (P = 0.03). S and SLSI treatments improved clinical and EMG parameters comparable to OCTR in short term. However, these beneficial effects were transient in the sixth month follow-up and OCTR was superior to conservative treatments.
Both rheumatoid arthritis (RA) and psoriatic arthritis (PsA) have a negative impact on patients' quality of life (QOL). The aim of this study was to compare QOL and life satisfaction in patients with RA and PsA. Forty patients with PsA, 40 patients with RA, and 40 healthy control subjects were included in the study. Demographic data and clinical characteristics including age, sex, disease duration, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), peripheral pain assessed by visual analog scale (VAS) and Larsen scores of hand X-rays were recorded. Nottingham Health Profile (NHP) was used to evaluate QOL, and Life satisfaction index (LSI) was used to measure psychological well-being in both groups. The demographic data of the subjects were similar between the groups. The scores of all NHP subscales were significantly higher and the scores of LSI were significantly lower in PsA and RA patients than in control subjects. The inflammation markers including ESR, CRP, pain by VAS and Larsen scores were found to be significantly higher in RA patients. The scores of LSI were similar between the groups. Although the scores of physical domains of NHP (pain and physical disability) were statistically higher in RA patients (p<0.05), the scores of psychosocial subgroups of NHP were similar between RA and PsA patients (p>0.05). Both PsA and RA patients had disturbed QOL and decreased life satisfaction. In conclusion, peripheral joint damage, inflammation, and physical disability are significantly greater in RA but psychosocial reflection of QOL and life satisfaction are the same for both groups which can be explained by the additional impact of skin disease in patients with PsA.
Quality of life (QoL) and life satisfaction (LS) are important outcome factors in chronic inflammatory conditions such as Behçet's disease (BD). The aim of this study was to investigate QoL and LS in patients with BD and determine the relationship with disease activity. Forty-one patients with BD and 40 control subjects were involved in the study. Demographic properties were obtained. Disease activity was assessed by Turkish version of BD Current Activity Form (BDCAF) in BD patients. QoL and psychological well-being were assessed by Nottingham Health Profile (NHP) and Life Satisfaction Index (LSI), respectively, in both patients and control groups. The related disease activity measures of QoL and LS were determined. Twenty-two male and 19 female BD patients with a mean age of 33.3+/-9.3 years and 20 male and 20 female control subjects with a mean age of 33.3+/-4.1 years were involved. According to BDCAF, no patient had central nervous system involvement. Thirty-four patients had headache, 33 patients had fatigue, 30 patients had articular involvement, 29 had mucocutaneous lesions, 27 had gastrointestinal involvement, 21 patients had ocular involvement, and 7 patients had vascular involvement. The scores of all dimensions of NHP were significantly higher and the mean score of LSI was significantly lower in BD patients than in control subjects (p<0.001). Correlation analysis indicated that the scores of fatigue, joint involvement, and oral ulcers were the most related factors for physical domains of NHP, whereas joint involvement and genital ulcers were the most related activity measures for psychosocial subscales of NHP. LS was found to be most related with the scores of patient's and physician's impression of disease activity and joint involvement. In conclusion, patients with BD have impaired QoL and disturbed psychological well-being. Current management strategies focusing on fatigue, arthralgia, mucocutaneous lesions, and efforts to measure psychosocial aspects and symptoms of the patients by their point of view will help to improve QoL and raise the LS in patients suffering from BD.
The aim of the study was to evaluate entheseal involvement in the foot of patients with spondyloarthropathy (SpA) by ultrasonographic (US) examination and compare the results with clinical and radiological findings. Forty-four patients (27 men, 17 women) with a diagnosis of SpA were recruited. Patient evaluation included physical examination (swelling and pain), Bath Ankylosing Spondylitis Radiological Index, Bath Ankylosing Spondylitis Disease Activity, Bath Ankylosing Spondylitis Metrological Index, and laboratory parameters (erythrocyte sedimentation rate, C-reactive protein). Foot x-rays of the patients were assessed and scored according to SpA Tarsal Radiographic Index (SpA-TRI). A high-resolution US was used to examine the tendon and ligament insertion sites in the foot, and the findings were scored according to Glasgow Ultrasound Enthesitis Scoring System (GUESS). The mean age and disease duration of the patients were 39.9+/-12.5 and 9+/-8.2 years, respectively. US revealed pathological findings in 25 of 44 (56.8%) patients, most of whom exhibited no clinical signs of foot involvement. Pain and swelling at entheseal insertions were detected in only 16 (37%) patients. The mean GUESS score and SpA-TRI score were 2.2+/-2.5 and 3.3+/-3.7, respectively. There was a correlation between the scores of GUESS and SpA-TRI, particularly at the Achilles and plantar fascia insertion sites. The mean score of SpA-TRI was higher in patients with enthesopathy, detected by US, than in patients without enthesopathy (4.6+/-4.4 vs 1.8+/-2.1). There was no significant correlation between the mean GUESS score and clinical and laboratory variables. In conclusion, involvement of tendon and entheses is not rare, and US is a valuable diagnostic method in detecting subclinical enthesopathic changes. The GUESS and SpA-TRI are suggested in quantifying US and radiological changes in the foot of patients with SpA.
OBJECTIVE: To carry out a cross-sectional study of patients with rheumatoid arthritis (RA) for hand disability, articular damage and to define their relation with demographic, laboratory and clinical parameters. METHODS: The study included 105 RA patients with a mean age of 49.4 years. Demographic parameters of the patients were recorded. Clinical parameters including disease duration, duration of morning stiffness, pain assessed by visual analog scale, Ritchie Articular Index, grip strength, lateral, tip and three-fingered pinch, and laboratory parameters comprising C-reactive protein, erythrocyte sedimentation rate and rheumatoid factor were evaluated in all patients. The Rheumatoid Arthritis Articular Damage (RAAD) score was used to assess the irreversible articular damage and deformities of the hand. Hand disability was assessed by the special hand disability index of Standford Health Assessment Questionnaire (HAQ). RESULTS: Hand disabilities of various levels were detected in 81% of the patients. Disease duration, grip strength, pinch measurements, clinical and laboratory activity parameters were strongly correlated with hand disability (p<0.01). Hand disability was more related to disease activity parameters than articular damage (p<0.01 and p<0.05, respectively). Grip strength and pinch measurements were the most related parameters with hand disability. The disability scores were significantly higher in female patients (p<0.01). The RAAD score was correlated with disease duration and grip strength (p<0.01). The clinical and laboratory parameters and seropositivity were not correlated with articular damage assessed by RAAD score (p>0.05). CONCLUSION: Our data suggest that grip strength and pinch measurements seem to be the most related variables with hand disability and articular damage. Therefore, grip strength and pinch measurement should be included in the evaluation and follow-up of the patients with RA in hand rehabilitation units.
OBJECTIVE: The aim of this study was to determine the prevalence of joint hypermobility among high school students and to define the characteristics of patients with joint hypermobility. METHODS: The students underwent complete history and physical examination. In order to designate marfanoid habitus, body weight, height, and span/height and upper/lower segment ratios were recorded. The degree of joint hypermobility was scored by the Beighton scoring system. The following features were also examined: arthralgia, myalgia, low back pain, sciatica, spinal deformities, temporomandibular joint pain and crepitus, effusion, swan neck deformity, arachnodactyly, joint dislocation, joint sprain, Raynaud's phenomenon, stria, varicose veins, abdominal and inguinal hernia, heart disease history, myopia, dropping eyelids, and antimongoloid slant. RESULTS: Eight hundred sixty-one students (433 females and 428 males) with a mean age of 15.4+/-1.1 years (range 13-19) were examined. Joint hypermobility was observed in 101 (11.7%) of the students. According to the Beighton scoring system, the majority of these (61.4%) were observed to score 4. Our results show that phenotype has no relation with joint mobility. Of the total number of students, there were 31 male (7.2%) and 70 female (16.2%) hypermobile subjects. The difference between sexes was highly significant (P=0.00005). Joint sprain was detected in 14 of hypermobile students (13.9%) and 50 of nonhypermobile students (6.6%). Its presence was the only significant parameter between hypermobile and nonhypermobile students (P=0.0094). CONCLUSIONS: Joint hypermobility was found in 11.7% of the students in our study, and the results are in harmony with the previous studies on Western populations. Although hypermobility does not seem to be very problematic in young people, as in our focus group, we believe that it is important for physicians to recognize this problem to ensure correct diagnosis and treatment, since it may lead to mimic rheumatic diseases in the future.
BACKGROUND: Polyarticular involvement, wrist and ankle arthritis are uncommon presentation of skeletal tuberculosis. Tuberculosis of the breast is also extremely rare. CASE PRESENTATION: Wrist, ankle and breast involvement were detected in the same patient. Mycobacterium tuberculosis was isolated from both synovial and breast biopsy specimen cultures. CONCLUSIONS: In general, tuberculosis arthritis is a frequently missed diagnosis, especially in different clinical patterns. A high level of suspicion is required particularly in high-risk populations and endemic areas.
Tuberculosis (Tbc) remains as a major public health problem in the world. Extrapulmonary Tbc is gaining importance and it accounts for approximately 15% of all new cases. Osteoarticular Tbc is an infrequent form of the disease, accounting for 1-5% of all cases. Joints are uncommon site of infection; therefore, peripheral Tbc is considered rare. Tbc arthritis are usually monoarticular but oligoarticular involvement are also reported. We presented here four cases with osteoarticular Tbc and reviewed the literature.
The aim of this study was to evaluate functional disability and quality of life (QOL) in patients with ankylosing spondylitis (AS) and determine the relationship between functional status and measures of clinical condition including QOL. Fifty-one AS patients (45 male, six female) with a mean age of 37.2+/-10.8 years were included. The demographic data of the patients were recorded. Their clinical status was assessed using the Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Radiology Index (BASRI), and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Global pain of the patients was determined with a visual analog scale (VAS), and QOL status was evaluated with the Nottingham Health Profile (NHP). Twenty-seven patients (52.9%) had peripheral articular involvement. Sixty percent had mild-to-moderate and 25.4% of the patients had severe functional disability, while 5.8% did not report any functional loss. A significant change in the mean scores of all clinical measures except BASRI was observed between patients with and without peripheral arthritis. The clinical measures of disease (BASRI, BASMI, and BASDAI) were all correlated with each other and with laboratory variables. The strongest factors correlating with functional loss were BASMI and BASDAI. The scores of all sections of the NHP were significantly higher, indicating a poor quality of life in AS patients. Peripheral joint involvement had a significant role in the deterioration of QOL. Physical domains of NHP such as pain and physical activity had highest correlations with functional disability, whereas psychosocial domains of NHP were found to correlate more highly with BASDAI and VAS pain scores. These results show the effect of AS, especially when the disease is active and associated with peripheral involvement. In conclusion, current management strategies should focus on decreasing pain, maintaining physical activity, and efforts to improve psychosocial health aspects for increasing QOL in patients suffering from AS.
The literature on the efficacy of traction in the treatment of low back pain (LBP) is conflicting. The aim of this study was to examine its efficacy in this disorder. Forty-two patients with at least 6 weeks of nonspecific LBP were selected. Demographic data were obtained. All patients completed the Oswestry disability index (ODI) to assess disability and the 10-cm visual analog scale (VAS) for evaluation of pain. Subjects were randomly assigned into group 1, receiving only standard physical therapy, or group 2, receiving standard physical therapy with conventional lumbar traction. Standard physical therapy consisted of local heat, ultrasound for the lumbar region, and an active exercise program, given for ten sessions in all. The subjects received instruction on correct posture and recommended therapeutic exercises. They were reevaluated at the end of treatment and at 3-month follow-up. The mean outcome measures were global improvement and satisfaction with the therapy, as well as disability by ODI and pain by VAS. There were no group differences in terms of demographic and baseline clinical characteristics. There was a significant reduction in pain intensity and disability at the end of treatment in both groups. There was complete or mild improvement in 47.6% of group 1 and 40% of group 2. The satisfaction rate with both treatments was more than 70% immediately after the therapies. During the 3-month period, the outcome measures except disability remained statistically stable, with no difference amongst groups. Disability was significantly reduced at follow-up in both groups. Of the patients, 51% continued with the recommended exercises and had significantly lower disability scores than those who did not continue with the exercises. Pain and global improvement were also better in this group, but the difference was not statistically significant. In conclusion, no specific effect of traction on standard physical therapy was observed in our study group. We suggest focusing on back education and exercise therapy in the management of patients suffering from this chronic condition.
Ochronotic arthropathy is the musculoskeletal manifestation of alkaptonuria. an uncommon inherited metabolic disorder associated with various clinical and radiologic abnormalities due to the deposition of homogentisic acid. We report on a 35-year-old man with ochronotic arthropathy who presented with the main characteristic radiological findings. The differential diagnosis of this rare condition is discussed with a review of the literature.
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