Polypharmacy, Physical and Nutritional Status, and Depression in the Elderly: Do Polypharmacy Deserve Some Credits in These Problems?

Background: To investigate the association of polypharmacy with physical function, nutritional status, and depression in the elderly. Method: The study included 675 people aged over 65 years from 8 centers in various geographical regions. The polypharmacy status was categorized as non-polypharmacy (0-4 drugs), polypharmacy (≥5 drugs). The subjects' physical function was assessed based on their "physical activity levels, Holden ambulation scores, gait speeds, and hand grip strengths"; their nutritional status based on the "Mini Nutritional Assessment (MNA)"; and their psychological status based on the "Center for Epidemiologic Studies Depression Scale -CES-D". Results: The presence of polypharmacy in this population was found to be 30% (n = 203). A statistically significant difference was found between the groups on the level of physical activity, Holden ambulation score, and nutrition status (p < .05). There was a statistically significant difference between the groups also on hand grip strength, MNA score, Charlson score (p < .05). Conclusion: Polypharmacy was observed to have a significant association with physical function, nutrition, and depression in the elderly aged ≥ 65 years.

Does Vitamin D Affect Diabetic Neuropathic Pain and Balance?

Purpose

This randomized, placebo-controlled study examined the effect of vitamin D replacement therapy on neuropathic symptoms and balance in patients with diabetic neuropathic pain and low vitamin D levels.

Patients and Methods

Among the 258 patients, the results in a total of 57 volunteers (32 in the treatment and 25 in the control arm) meeting the inclusion criteria are reported. Symptoms of neuropathic pain were assessed using Douleur Neuropathique 4 (DN4) questionnaire, and presence of polyneuropathy (PNP) was determined by performing electromyography (EMG). Balance was assessed using Berg balance test (BBT). After undergoing these examinations, the patients in the treatment group were intramuscularly (IM) injected with 300,000 IU vitamin D in a liquid formulation and those in the placebo group were IM injected with physiological saline. The DN4 and BBT were repeated after 12 weeks, and the results were compared.

Results

The patients in the treatment group showed a significant decrease in total DN4 scores from baseline to the study endpoint compared with the patients in the placebo group (p=0.008). The patients in the treatment group also showed a significant increase in BBT scores from baseline to the study endpoint compared with the patients in the placebo group (p=0.001). Furthermore, in subgroup analysis, these patients showed a significant decrease in electric shock and burning sensation scores from baseline to the study endpoint compared with the patients in the placebo group (p=0.006, p=0.001, respectively).

Conclusion

In patients with diabetic neuropathic pain, vitamin D levels should be measured and vitamin D replacement therapy should be administered as required to resolve neuropathic symptoms and to improve balance.

The effect of different irrigation protocols on elastic modulus of dentine and biomechanics of single-rooted premolar tooth: A nano-indentation and finite element analysis study

Aim

This study evaluated the effect of different irrigation protocols on elastic modulus and biomechanics of single-rooted premolar tooth using with nano-indentation and finite element analysis (FEA).

Materials and Methods

Root canals of single-rooted human teeth were prepared, divided into eight groups, and irrigated with (1) 2.5% NaOCl + 17% EDTA; (2) 2.5% NaOCl + 17% EDTA + 2.5% NaOCl; (3) 2.5% NaOCl + SmearClear; (4) 2.5% NaOCl + 2% chlorhexidine; (5) 1.3% NaOCl + MTAD; (6) 5.25% NaOCl; (7) 17% EDTA; and (8) saline. The roots were vertically sectioned, and elastic modulus of the root dentine was measured using nano-indenter device at coronal, middle, and apical third. Data were recorded as megapascal and statistically analyzed (one-way analysis of variance, Tukey tests). Three-dimensional FEA model of a premolar tooth was created, and the inner root dentine was modified to simulate the effect of irrigation protocols on root dentine. The elastic properties of inner root dentine layer in the FEA models were modified for each group according to the data obtained with nano-indentation. A 300-N load was applied at the buccal cusp and central fossa of the models with a 45° angle. The stresses were calculated using von Mises stress criteria.

Results

All irrigation protocols affected the elastic modulus of root dentine. Groups 2 and 3 showed similar elastic modulus values (P > 0.05), whereas the lowest values were obtained in group 7 (P < 0.05). No statistically significant differences were found between groups 4, 5, and 8 (P > 0.05).

Conclusion

Despite the effect of different clinically used irrigation protocols on elastic modulus of the inner dentine, this does not affect the biomechanics of the roots.

Resin infiltration technique and fluoride varnish on white spot lesions in children: Preliminary findings of a randomized clinical trial

Aim

To clinically assess the efficacy of resin infiltration versus fluoride varnish for arresting white spot lesions (WSLs) on permanent teeth in children.

Subjects and Methods

Among the children referred to the our University, Faculty of Dentistry, Department of Pediatric Dentistry, 23 aged between 8-14 with 81 anterior WSLs were included in the study. The participants were randomly assigned to either the resin infiltration group or the fluoride varnish group. WSLs were assessed using a laser fluorescence device (DIAGNOdent pen, Kavo, Germany) and were characterized at baseline, immediately following resin infiltration application and at a 6-month follow-up. For the statistical analyses, the IBM SPSS Statistics 22 (IBM SPSS, Turkey) program was used to assess the findings of the study.

Results

Participant retention was 100% at 6 months. There was no significant difference between the two groups when baseline DIAGNOdent (DD) values were compared (P > 0.05). The reduction in 6-month follow-up DD values were statistically significant in both groups relative to baseline values. The 6-month values of the resin infiltration group were statistically lower than those of the fluoride varnish group (P = 0.028, P < 0.05).

Conclusions

Resin infiltration and fluoride varnish are clinically feasible and efficacious methods for the treatment of anterior WSLs. The inhibition of caries progression by resin infiltration should now be considered an alternative to fluoride treatment.

A randomized, double-blind study to assess if vitamin D treatment affects the outcomes of rehabilitation and balance in hemiplegic patients

[Purpose] To investigate the effect of vitamin D supplementation on rehabilitation outcomes and balance in patients having hemiplegia due to ischemic stroke. [Subjects and Methods] Vitamin D levels of 132 patients hospitalized for hemiplegia rehabilitation due to ischemic stroke were tested. Consequently, 86/132 patients had low vitamin D levels, 72 of which met the inclusion criteria and were included in the study. Patients were divided into two groups: Group A (injected with 300,000 IU vitamin D), and Group B (injected intramuscularly with saline). Each patient was tested at the baseline and at the third month using the Brunnstrom recovery staging, functional ambulation scale, modified Barthel index, and Berg balance scale. The findings were compared between the groups. [Results] By the end of the third month, The Berg balance scale results and modified Barthel index scores significantly differed between the two groups, whereas Brunnstrom recovery staging and functional ambulation scale test results did not. [Conclusion] This study found that vitamin D administration increased the activity levels and accelerated balance recovery but did not significantly affect ambulation or motor recovery. These results warrant confirmation by longer follow-up studies with a larger number of participants.

Reliability of the Modified Ashworth Scale and Modified Tardieu Scale in patients with spinal cord injuries

STUDY DESIGN

Psychometrics study.

OBJECTIVES

To assess the reliability of the Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS) in patients with spinal cord injuries (SCIs).

SETTING

Inpatient rehabilitation clinics at two state hospitals.

METHODS

The study included 65 participants aged between 18 and 88 years with SCI with spasticity. All participants were at least 6 months after injury and had an American Spinal Injury Association Impairment Scale grade of A-D. The MAS and MTS scores were collected from the right hip adductor and hip extensor muscles, right knee extensor and knee flexor muscles and right plantar flexor muscles. Each participant was assessed twice by two experienced physiatrists 1 week apart. The raters were blinded to each other's scores.

RESULTS

Inter-rater and test-retest agreement for the MAS scores (κ=0.531-0.774) was moderate to substantial. Inter-rater and test-retest agreement for the MTS X scores (κ=0.692-0.917) was substantial to almost perfect. Inter-rater reliability and test-retest reliability of the MTS R2-R1 was excellent (intra-class correlation coefficient (ICC) 0.874-0.973, confidence interval (CI): 0.79-0.98) for all muscles tested. Inter-rater reliability of the MTS R2 for the hip adductor and knee extensor muscles was poor (ICC 0.248, CI: -0.00 to 0.47 and ICC 0.094, CI: -0.16 to 0.34, respectively). The test-retest reliability of the MTS R2 was also poor for the knee extensor muscles (ICC 0.318, CI: -0.06 to 0.53).

CONCLUSION

MAS has adequate reliability for determining lower-extremity spasticity in patients with SCI. The demonstration of excellent inter-rater reliability and test-retest reliability of the MTS R2-R1 suggests its utility as a complementary tool for informing treatment decisions in patients with SCI.

A novel quantitative light-induced fluorescence device for monitoring molar-incisor hypomineralization

BACKGROUND

The FluoreCam system is based on an innovative approach to the quantification of enamel health termed fluorescence enamel imaging (FEI). Enamel is both highly mineralized and semi-translucent. Because of its mineral composition, enamel will fluoresce when exposed to certain light wavelengths. The semi-translucent nature of enamel results in different enamel densities emitting different levels of fluorescence. As a result, with FEI technology, one can measure the density of tooth enamel by measuring its fluorescence when subjected to specific light wavelengths.

PURPOSE

To determine the ability of visual examination and the instrumental procedures of the FluoreCam to monitor molar-incisor hypomineralization (MIH) lesions.

SUBJECTS AND METHODS

This study involved children with MIH at the Department of Paediatric Dentistry, Marmara University. In total, 11 patients with MIH were diagnosed on a visual MIH scale and evaluated with the FluoreCam. The equipment, data processing, and interaction between the equipment and operator were evaluated.

RESULTS

Fluorescent images recorded with the custom software, the clinical view, and digital numeric values were evaluated to assess the potential for use of the device in clinical practice.

CONCLUSION

These preliminary data from an ongoing clinical study suggest that measurements with the FluoreCam are useful in monitoring MIH. This technique also provides visual and quantitative feedback to patients.

Isokinetic Evaluation of Knee Extensor/Flexor Muscle Strength in Behcet's Patients

BACKGROUND

Behçet's disease (BD) is an idiopathic, multisystemic, progressive disease. The purpose of this study is to compare the knee flexor and extensor isokinetic muscle strengths of Behcet's patients with that of healthy subjects.

METHODS

Twenty-five (13 male and 12 female) patients with BD and 25 (15 male and 10 female) healthy individuals were included in the study. Velocities of 90°/sec, 120°/sec, and 150°/sec were used for the isokinetic muscle strength testing. Patients with active inflammatory knee arthritis were excluded. Peak torque (Nm) and peak torque adjusted to body weight (%) were taken into consideration for comparison between study groups.

RESULTS

Compared to healthy controls, there was a statistically significant decrease in both the bilateral knee extensor and flexor muscle isokinetic peak torques(Nm) as well as the peak torques adjusted to body weight (%) at velocities of 90°/sec, 120°/sec and 150°/sec in patients with BD (p < 0.05). However, there was no significant difference in the agonist-antagonist ratio of the isokinetic peak torques of knee muscles between the two groups.

CONCLUSION

In light of these findings, we have concluded that both knee flexor and extensor isokinetic muscle strengths are lower in BD. We therefore recommend careful monitoring of patients with BD in terms of muscle strength.

Comorbidities in patients with psoriatic arthritis: a comparison with rheumatoid arthritis and psoriasis

AIM

Psoriatic arthritis (PsA) is a chronic, inflammatory disease. The purpose of this study was to examine the association between PsA and comorbid conditions. This is the first study to investigate comorbid diseases in PsA in Turkey.

METHODS

This study was performed under the auspices of the Anatolian Group for the Assessment in Rheumatic Diseases (ANGARD) and involved participation by six university research hospitals. Patients diagnosed with and treated for PsA on the basis of clinical, radiological and laboratory findings and expert opinion were monitored using standardized examination methods and jointly prepared forms. Clinical status, accompanying systemic diseases and surgical history were recorded.

RESULTS

One hundred and seventy-three patients with PsA (75 male, 98 female, mean age 41.8) and 138 patients with rheumatoid arthritis (RA) (17 male, 121 female, mean age 48.6) and 67 with psoriasis (PsO) (43 male, 24 female, mean age 36.1) were included in the study. No accompanying disease was determined in 72.8% of PsA, 50.0% of RA and 80.6% of PsO groups. In regression analysis, patients with PsA had higher risk for cataract/glaucoma surgery (odds ratio [OR] = 11.99; 95% CI 1.36-105.4, P = 0.025) compared to patients with RA, and higher risk for hypertension (HT) (OR = 4.26; 95% CI 1.27-14.23, P = 0.018) compared to the patients with PsO.

CONCLUSION

Patients with PsA have relatively lower frequency of comorbidities like diabetes mellitus, HT and cataract/glaucoma surgery compared to the patients with RA. The increased risk for having cataract/glaucoma surgery in RA compared to PsA may be particularly attributed to the more prevalent glucocorticoid use in RA.

Frailty prevalence and related factors in the older adult-FrailTURK Project

Frailty is one of the geriatric syndromes and has an important relationship with mortality and morbidity. The aim of this study is to present the characteristics, prevalence, and related factors of frailty in older adults in our country. The study included 1126 individuals over 65 years of age from 13 centers. Frailty was evaluated using the Fried Frailty criteria, and patients were grouped as "frail," "pre-frail," and "non-frail." Nutritional status was assessed with "Mini Nutritional Test," psychological status with the "Center for Epidemiological Studies Depression Scale-CES-D," and additional diseases with the "Charlson Comorbidity index." Approximately 66.5 % of the participants were between 65 and 74 years of age and 65.7 % were women. Some 39.2 and 43.3 % of the participants were rated as frail and pre-frail, respectively. The multinomial logistic regression analysis was used to determine the factors associated with frailty. It was observed that age, female gender, low education level, being a housewife, living with the family, being sedentary, presence of an additional disease, using 4 or more drugs/day, avoiding to go outside, at least one visit to any emergency department within the past year, hospitalization within the past year, non-functional ambulation, and malnutrition increased the risk of frailty (p < 0.05). Establishing the factors associated with frailty is highly important for both clinical practice and national economy. This is the first study on this subject in our country and will provide guidance in determining treatment strategies.

The examination of protective effects of gallic acid against damage of oxidative stress during induced-experimental renal ischemia-reperfusion in experiment

AIM

In this study, probable effects of gallic acid were investigated in experimentally induced renal I/R injury in rats.

MATERIAL AND METHODS

For this purpose, each group consisted of 7 Spraque dawley male albino rats. Groups were defined as follows; Group I: control group; Group II: I/R group; Group III, IV and V: I/R+Gallic acid (50, 100 and 200 mg.kg-1 respectively-i.p.). Left kidney was removed by nephrectomy except for Group I. I/R was induced in the other kidney. Gallic acid was given 15 mins before ischemia induction. SOD, CAT and Gpx activities were determined by electrophoresis. MDA, MPO levels were determined spectrophotometrically. Histopathological investigations were also performed in kidney tissues. BUN and Creatinine levels in serum were determined.

RESULTS

BUN, Creatinine and MDA levels were statistically significant but MPO level was not statistically significantly increased in Group II. For SOD, CAT, Gpx activities in Group II, an increase was determined with respect to Group I. Histopathological investigations revealed widespread hyperemia in glomerulus, expansion of the structure between tubules and cell disruptions in Group II. In Group V (200 mg.kg-1 gallic acid), in terms of biochemical parameters, in spite of the significant decrease in BUN, Creatinine and MDA levels; a decrease was determined in SOD, CAT and Gpx isoenzyme activities. Group V showed histologically that I/R injury had been prevented to a greater extent and appearances were close to the control.

CONCLUSION

As a result, in terms of our study, evaluations regarding kidney functions and histopathology have shown that gallic acid has protective effects in renal I/R injury (Tab. 2, Fig. 5, Ref. 36).

Temporomandibular disorders in young people with an intellectual disability: prevalence of signs and symptoms

AIM

To assess the prevalence of signs and symptoms related to TMJ disorders in a group of young people with intelectual disability (ID) and a matched group of healthy adolescents.

MATERIALS AND METHODS

A group of 105 young Special Olympics (SO) athletes (ID group) aged from 14 to 25 years and a control group were examined for the presence or absence of signs and symptoms of TMD through interview and clinical examination.

RESULTS

A total of 64 young people with ID (61%) had at least one sign of TMD compared to 41 (39%) of the individuals screened that was free of any TMD symptoms. A significantly higher prevalence of TMJ sounds (palpation and stethoscope), TMJ tenderness, maximum vertical opening, headaches were observed among SO athletes compared to the healthy control group (p<0.05). A significant difference was recorded only for the Temporalis tenderness between the girls and boys (p<0.05).

CONCLUSION

TMJ disorders are noticeable problem for intellectually disabled patients and a possible cause of pain that should be examined more in detail. We suggest that oral screening in people with a mental disability should be modified by including basic TMJ examination parameters in order to allow better understanding of the pathological aspects so as to address effective preventive and therapeutic measures.

Isokinetic Evaluation of Knee Extensor/Flexor Muscle Strength in Behcet's Patients

Background: Behçet's disease (BD) is an idiopathic, multisystemic, progressive disease. The purpose of this study is to compare the knee flexor and extensor isokinetic muscle strengths of Behcet's patients with that of healthy subjects. Methods: Twenty-five (13 male and 12 female) patients with BD and 25 (15 male and 10 female) healthy individuals were included in the study. Velocities of 90°/sec, 120°/sec, and 150°/sec were used for the isokinetic muscle strength testing. Patients with active inflammatory knee arthritis were excluded. Peak torque (Nm) and peak torque adjusted to body weight (%) were taken into consideration for comparison between study groups. Results: Compared to healthy controls, there was a statistically significant decrease in both the bilateral knee extensor and flexor muscle isokinetic peak torques(Nm) as well as the peak torques adjusted to body weight (%) at velocities of 90°/sec, 120°/sec and 150°/sec in patients with BD (p < 0.05). However, there was no significant difference in the agonist-antagonist ratio of the isokinetic peak torques of knee muscles between the two groups. Conclusion: In light of these findings, we have concluded that both knee flexor and extensor isokinetic muscle strengths are lower in BD. We therefore recommend careful monitoring of patients with BD in terms of muscle strength.

Microleakage of new glass ionomer restorative materials in permanent teeth

AIM

The aim of this in vitro study was to evaluate the microleakage of the new glass ionomers ChemFil Rock and IonoluxAC in comparison to Fuji IX GP Extra and the composite Aelite LS Posterior in permanent teeth.

MATERIALS AND METHODS

Class V standardised U-shaped cavities were made on a total of 40 freshly extracted teeth and restored with different glass ionomer materials (4 groups of 10 samples each). After thermocycling, the teeth were immersed in 0.5% basic fuchsin for 24h. They were then sectioned in the buccolingual direction. Microleakage was assessed for the occlusal and gingival margins under a microscope at 40x magnification.

RESULTS

There were significant differences among the materials used (p=0.000). While there was no dye penetration in the Fuji IX GP EXTRA group, which behaved similarly to the composite resin group, ChemFil Rock showed less microleakage than Ionolux AC. The Wilcoxon rank test showed no significant differences in the occlusal and gingival scores between the groups (p>0.05).

CONCLUSION

Although cavities filled with a conventional glass ionomer (Fuji IX GP Extra) had significantly less leakage than cavities filled with the new glass ionomers (ChemFil Rock and Ionolux AC), these results do not reflect all the variables present in vivo conditions. As the in vitro evaluation of new materials does not always reveal their full limitations or possibilities, clinical testing of new systems remains the ultimate proof of effectiveness.

Does vitamin D affect disease severity in patients with ankylosing spondylitis?

BACKGROUND

Vitamin D has been found to have a role in the function of the immune system. There have been a lot of studies investigating a relation between vitamin D and disease activity in ankylosing spondylitis (AS). However, there have not been any studies arranging AS in groups according to vitamin D levels and determining any differences among these patients in terms of disease activity, functional status, quality of life, and other clinical parameters. The aim of this study is to compare 25-hydroxy-vitamin D3 (25(OH)D3) levels in AS patients with those in normal healthy subjects and to determine the relationship between 25(OH)D3 levels and AS disease activity, functional status, and quality of life.

METHODS

Ninety-nine consecutive patients and 42 healthy volunteers were included in this study. After a comparison between the patient group and the control group, the patient group was divided into normal, insufficient and deficient subgroups according to the plasma 25(OH)D3 levels for another comparison.

RESULTS

The differences in the 25(OH)D3 level between the patient and the control groups were statistically insignificant. The number of AS patients whose 25(OH)D3 levels were classified as normal, insufficient, and deficient were 34, 29, and 36, respectively. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and Bath AS Disease Activity Index (BASDAI) scores were higher in the low (including insufficient and deficient) 25(OH)D3 level subgroups (P < 0.05). The Bath AS Functional Index (BASFI) and AS Quality of Life (ASQoL) scores were significantly different between the normal and the deficient subgroups (P < 0.05). Pain, BASDAI, ESR, and CRP were inversely correlated to the 25(OH)D3 levels (P < 0.05).

CONCLUSIONS

The plasma 25(OH)D3 levels may decrease in AS patients and this may negatively affect disease activity, functional status and quality of life.

Psychological status is associated with health related quality of life in patients with rheumatoid arthritis

OBJECTIVE

Rheumatoid arthritis (RA) is a chronic and disabling disease frequently effects physical and psychological well being. The aim of the present study was to determine the impact of psychological status on health related quality of life in patients with RA and also to assess which quality of life (QoL) instrument - disease specific and generic - is more prone to this effect.

METHODS

A total of 421 patients with RA recruited from joint database of five tertiary centers. Depression and anxiety risks were assessed by the Hospital Anxiety and Depression Scale (HADS); and quality of life assessed by Rheumatoid Arthritis Quality of Life (RAQoL), Nottingham Health Profile (NHP) and The Short Form 36 (SF 36) questionnaire.

RESULTS

Patients with higher risk for depression or anxiety had poorer quality of life compared to the patients without risk for depression or anxiety. Depression and anxiety scores significantly correlated with quality of life questionnaires. There was significant association between anxiety and depression with worsening in both disease specific and generic health related quality of life. However, RAQoL showed more association with depression and anxiety levels.

CONCLUSION

Higher depression and anxiety risks showed increased deterioration in quality of life. Compared to generic QoL scales, RAQoL scale, a disease specific QoL instrument, is much more influenced by depression and anxiety.

Effectiveness of back school for treatment of pain and functional disability in patients with chronic low back pain: a randomized controlled trial

OBJECTIVE

To evaluate the effectiveness of the addition of back school to exercise and physical treatment modalities in relieving pain and improving the functional status of patients with chronic low back pain.

DESIGN

A randomized controlled trial.

PATIENTS

A total of 146 patients with chronic low back pain were enrolled in the study.

METHODS

Subjects were divided into 2 groups: the back school group received exercise, physical treatment modalities and a back school programme; and the control group received exercise and physical treatment modalities. Treatment efficacy was evaluated at the end of treatment and 3 months post-treatment, in terms of pain, measured with the Visual Analogue Scale, and functional status, measured with the Oswestry Low Back Pain Disability Questionnaire.

RESULTS

In both groups, Visual Analogue Scale and Oswestry Low Back Pain Disability Questionnaire were significantly reduced after therapy (p < 0.01), but the difference between the scores at the end of treatment and 3 months post-treatment was not significant. There was a significant improvement in Visual Analogue Scale and Oswestry Low Back Pain Disability Questionnaire in the back school group compared with the control group at the end of therapy and 3 months post-treatment (p < 0.05).

CONCLUSION

The addition of back school was more effective than exercise and physical treatment modalities alone in the treatment of patients with chronic low back pain.

Gain in visual acuity after cataract surgery improves postural stability and mobility

OBJECTIVES

Vision plays an important role in postural stability. It has also been shown that visual information from the environment and visual cues significantly contribute to balance skills. The aim of this study was to investigate the effects of visual acuity on postural stability and mobility before and after cataract surgery.

METHODS

The study group was composed of 25 male and 11 female patients (age 57-84, mean 66.6 +/- 4.7) who had been operated for age-related cataract. Postural stability and mobility were assessed before and four weeks after the surgery by means of Biodex stability system (BSS), Tinetti, Time up and go (TUG) and Functional reach (FR) tests, as well as by gait analysis (gait velocity, step length, step width, cadence, stride length).

RESULTS

Postoperative visual acuity was significantly improved. Gait velocity and cadence increased significantly but step length, stride length, and step width did not change significantly. Postoperative improvement of Tinetti balance, TUG and FR tests were significant. Similarly, antero-posterior stability index (APSI), mediolateral stability index (MLSI) and overall stability index (OSI) that were examined with BSS improved significantly after the cataract surgery.

CONCLUSION

These results demonstrated that gain in visual acuity after cataract surgery improves the postural stability and mobility of patients (Tab. 2, Fig. 1, Ref. 29). Full Text in free PDF www.bmj.sk.

Can the patient-reported outcome instruments determine disease activity in rheumatoid arthritis?

OBJECTIVES

The aim of this study was to investigate the indicative value of the patient-reported outcome instruments (PROs) on disease activity in rheumatoid arthritis (RA).

METHODS

Three hundred sixty eight patients with RA were included in this cross-sectional study. Disease activity was evaluated using both the Disease Activity Score 28 (DAS 28) and the Clinical Disease Activity Index (CDAI). Patients who had DAS 28 score < 3.60 points and CDAI score <10.00 points were allocated into the "low disease activity" group and those who had DAS 28 score > or = 3.60 points and CDAI score > or = 10.00 points into the "moderate or high disease activity" group. The Health Assessment Questionnaire (HAQ), Nottingham Health Profile (NHP), Rheumatoid Arthritis Quality of Life (RAQoL), and Short Form 36 (SF 36) were used as PROs. Logistic regression analysis was used to find variables, which had an indicative value for disease activity.

RESULTS

HAQ, pain and emotional reaction subscales of NHP, and bodily pain, general health and social functioning subscales of SF 36 had independent indicative values, when DAS 28 was used as dependent variable. On the other hand, HAQ, pain and emotional reaction subscales of NHP, and general health and emotional role limitation subscales of SF 36 had indicative values when CDAI was used as dependent variable. DAS 28 and CDAI both showed HAQ as the parameter with the highest odds ratio (OR). But RAQoL had shown no independent indicative value for projecting disease activity.

CONCLUSION

It was concluded that HAQ could determine disease activity in RA better than other PROs included in this study (Tab. 4, Ref. 36).

Abdominal fat in children measured by ultrasound and computed tomography

The prevalence of childhood obesity is increasing rapidly. Visceral fat plays an important role in the pathogenesis of metabolic and cardiovascular diseases. Currently, computed tomography (CT) is broadly seen as the most accurate method of determining the amount of visceral fat. The main objective was to examine whether measures of abdominal visceral fat can be determined by ultrasound in children and whether CT can be replaced by ultrasound for this purpose. To assess whether preperitoneal fat thickness and area are good approximations of visceral fat at the umbilical level, we first retrospectively examined 47 CT scans of nonobese children (body mass index <30kg/m(2); median age 7.9 y [95% range 1.2 to 16.2]). Correlation coefficients between visceral and preperitoneal fat thickness and area were 0.58 (p<0.001) and 0.76 (p<0.001), respectively. Then, to assess how preperitoneal and subcutaneous fat thicknesses and areas measured by ultrasound compare with these parameters in CT, we examined 34 nonobese children (median age 9.5 [95% range 0.3 to 17.0]) by ultrasound and CT. Ultrasound measurements of preperitoneal and subcutaneous fat were correlated with CT measurements, with correlation coefficients ranging from 0.75-0.97 (all p<0.001). Systematic differences of up to 24.0cm(2) for preperitoneal fat area (95% confidence interval -29.9 to 77.9cm(2)) were observed when analyzing the results described by the Bland-Altman method. Our findings suggest that preperitoneal fat can be used as an approximation for visceral fat in children and that measuring abdominal fat with ultrasound in children is a valid method for epidemiological and clinical studies. However, the exact agreement between the ultrasound and CT scan was limited, which indicates that ultrasound should be used carefully for obtaining exact fat distribution measurements in individual children.

Pattern of disease onset, diagnostic delay, and clinical features in juvenile onset and adult onset ankylosing spondylitis

OBJECTIVE

To assess the frequency of juvenile onset ankylosing spondylitis (JOAS) in Turkish patients with AS and to compare with adult onset AS (AOAS) in a cross-sectional study design.

METHODS

A total of 322 patients were recruited from the joint database of 5 university hospitals in eastern Turkey.

RESULTS

Patients with JOAS (n = 43, 13.4%) had significantly longer diagnostic delay (9.21 vs 5.08 yrs), less severe axial involvement and more prevalent uveitis (OR 2.92, 95% CI 1.25-6.79), and peripheral involvement at onset (OR 3.25, 95% CI 1.51-6.98, adjusted for current age; and OR 2.26, 95% CI 1.07-4.76, adjusted for disease duration). Patients with AOAS had higher radiographic scores and more restricted clinimetrics but similar functional limitations and quality of life.

CONCLUSION

JOAS and AOAS had distinctive courses and Turkish patients with AS had similar features compared to other Caucasian patient populations.