Correlation of clinical signs and magnetic resonance imaging findings in patients with lumbar spondylosis

Objectives

The purpose of the study was to contribute further to this debated topic by investigating the correlation of magnetic resonance imaging (MRI) findings with the clinical picture in lumbar spondylosis patients.

Patients and methods

This multicenter retrospective study (as part of the epidemiological project of the TLAR-OASG [Turkish League Against Rheumatism-Osteoarthritis Study Group]) included 514 patients (101 males, 413 females; mean age: 63.6±10.8 years; range, 40 to 85 years) who were diagnosed as lumbar spondylosis by clinical examination and direct X-ray between December 2016 and June 2018. Demographic characteristics of patients, Visual Analog Scale for pain, presence of radiating pain, Roland-Morris disability questionnaire, straight leg raise test, deep tendon reflexes, neurogenic intermittent claudication symptoms, any decrease of muscle strength, and abnormality of sensation were recorded. Lumbar MRI findings of the patients were recorded as positive or negative in terms of disc herniation, intervertebral disc degeneration, root compression, osteophytes, spinal stenosis. Statistical analysis was done to assess the correlation between the clinical symptoms, physical examination, and MRI findings.

Results

Correlation analysis of the MRI results and the clinical findings showed a significant correlation between straight leg raise test and root compression (p<0.001, r=0.328) and a significant correlation between neurogenic intermittent claudication and spinal stenosis (p<0.001, r=0.376). Roland-Morris disability questionnaire had a significant correlation with all MRI findings (p<0.05, r<0.200).

Conclusion

The results of this study corroborate the notion that diligent patient history and physical examination are more valuable than MRI findings, even though a higher incidence of abnormal MRI findings have been obtained in patients with disability and dermatomal radiating pain.

Evaluation of 25(OH) vitamin D3 and quadriceps strength correlation in postmenopausal women: A cross-sectional study

BACKGROUND

Vitamin D deficiency is common in postmenopausal women and is associated with low vitamin D intake, increased age, decreased absorption. Especially at advanced age, vitamin D deficiency may increase muscle weakness and disbalance resulting in increased risk of fracture.

OBJECTIVES

This study aims to explore the correlation between 25(OH) vitamin D3 levels and quadriceps muscle strength in postmenopausal women.

METHODS

We evaluated bilateral qadriceps muscle strength in postmenopausal women with isokinetic test. We evaluated the correlation of muscle power with measurements of parathormone, vitamin D, Calcium, creatinine, alanine transaminase, alkaline phosphatase, total creatine kinase.

RESULTS

The mean vitamin D level of 95 participants included in the study was 18.24 ± 8.94 ng/ml. Vitamin D levels were found to be deficient (< 10 ng/ml) in 23 (24.1%), insufficient in 62 (65.26%) and normal in 10 (10.53%) of the 95 participants. A weak negative correlation was observed between participants' vitamin D levels and PT values (r=-0.271, p= 0.012). A moderate negative correlation was found between ALP and vitamin D levels (r=-0.317, p= 0.002). However, there was no significant correlation between vitamin D levels and the 60∘ and 90∘ flexion and extension peak torque values (All p values > 0.05).

CONCLUSIONS

Vitamin D levels and muscle strength weren't statistically significant. Few studies are available in the related literature, highlighting the need for further research to achieve a clearer consensus.

The clinical, functional, and radiological features of hand osteoarthritis: TLAR-osteoarthritis multi-center cohort study

Objectives

This study aims to evaluate the clinical, functional, and radiological features of hand osteoarthritis (OA) and to examine their relationships in different geographic samples of the Turkish population.

Patients and methods

Between April 2017 and January 2019, a total of 520 patients (49 males, 471 females; mean age: 63.6±9.8 years) with hand OA were included in the study from 26 centers across Turkey by the Turkish League Against Rheumatism (TLAR). The demographic characteristics, grip strengths with Jamar dynamometer, duration of hand pain (month), the severity of hand pain (Visual Analog Scale [VAS]), and morning stiffness were evaluated. The functional disability was evaluated with Duruöz Hand Index (DHI). The Kellgren-Lawrence (KL) OA scoring system was used to assess the radiological stage of hand OA.

Results

The DHI had significant correlations with VAS-pain (r=0.367, p<0.001), duration of pain (r=0.143, p=0.001) and bilateral handgrip strengths (r=-0.228, p=0.001; r=-0.303, p<0.001). Although DHI scores were similar between the groups in terms of the presence of hand deformity (p=0.125) or Heberden's nodes (p=0.640), the mean DHI scores were significantly higher in patients with Bouchard's nodes (p=0.015). The total number of nodes had no significant correlations with the VAS-pain and DHI score (p>0.05). The differences between the groups of radiological hand OA grades in terms of age (p=0.007), VAS-pain (p<0.001), duration of pain (p<0.001), and DHI (p<0.001) were significant. There were no significant differences between radiological hand OA grades according to the duration of the stiffness, grip strength, and BMI (p>0.05 for all).

Conclusion

In our population, the patients with hand OA had pain, functional disability, and weak grip strength. The functional impairment was significantly correlated with the severity of the pain, and the functional status was worse in high radiological hand OA grades.

The effect of prepartum intravaginal bacteriophage administration on the incidence of retained placenta and metritis

The objective of this study was to evaluate the effect of prepartum intravaginal administration of an anti-Escherichia coli bacteriophage cocktail on uterine health and reproductive performance of lactating dairy cows. The study was conducted on a commercial dairy farm located near Ithaca, New York, from March to September 2012, and 107 cows were enrolled. The cows were divided randomly into 2 groups (treatment and control); treatment group cows were submitted to 3 intravaginal administrations of 20 mL of a bacteriophage cocktail including 10 different phages in a lysate with titration of approximately 10(9) plaque-forming units, on d 230, 260, and 275 of gestation. Control cows were not treated with a placebo, and physical examination and sample collection was conducted equally for both groups. Vaginal swabs were collected at d 230, 260, and 275 d of gestation, cervical swabs were collected at 3±1 d in milk, and blood was collected at 275 d of gestation for nonesterified fatty acids and interleukin (IL)-6 serum level measurements and at 10 DIM for β-hydroxybutyrate and IL-6 serum level measurements. The bacteriophage cocktail significantly increased the incidence of retained placenta and metritis. Swab samples were cultured for E. coli and no difference was found between treatment and control groups. The lysate contained 6×10(9) IU of lipopolysaccharide/mL and could have caused prepartum overstimulation of toll-like receptor-4 (TLR4)-chemokine pathway, leading to a weaker immune response. However, IL-6 was not affected by treatment, although sample size was insufficient to prove a treatment effect on the suppression of the chemokine cascade and innate immune system. Bacteriophage treatment had an excellent bactericidal effect in previous in vitro trials; however, special attention must be given to production of the cocktail to obtain a purified solution free of E. coli bacterial products and fragments, particularly lipopolysaccharide.

Which is the dominant factor for perception of rheumatic pain: meteorology or psychology?

It is believed that there is an association between the weather and rheumatic symptoms. We aimed to investigate what kind of association is present and what are the factors which determine the nature of this association. Fifty-six subjects with rheumatic disease (31 RA, 15 SpA, 10 OA) who live in Antalya were followed between December 2005 and July 2006. Patients were asked to fill diaries which contain questions regarding the symptoms of their rheumatic diseases everyday. In every monthly visit, disease activity measurement, laboratory assessment and Beck depression inventory assessment were recorded. The symptomatic and psychological measurements were matched with the meteorological data of Antalya Regional Directorate of Meteorological Service of Turkish State. Correlation of symptoms with weather variables was investigated. Contributory effect of weather and of psychologic factors on symptom scores were evaluated by stepwise multiple regression analysis. Eighty-four percent of subjects belive in an association between weather and rheumatism, while 57% claimed to have ability to forecast weather. The maximum correlation coefficient between weather and arthritis symptoms was -0.451 and the maximum contribution of weather on symptoms was 17.1%. Arthritis symptoms were significantly contributed by Beck depression score. The belief about presence of weather-arthritis association was found to be stronger than its statistical power. Our results did not prove or rule out the presence of weather-rheumatism association. As long as the scientific attempts result in failure, the intuitive support in favour of the presence of weather-arthritis association will go on forever.

Vitamin E and aerobic exercise: effects on physical performance in older adults

BACKGROUND AND AIMS

Aerobic endurance exercise enhances antioxidant defenses and improves the physical performance of older adults. However, the combined effect on physical performance of exercise and an antioxidant such as vitamin E has not been investigated. The purpose of this study was to evaluate the effects of six months of vitamin E supplementation and supervised aerobic training on physical performance and body composition in sedentary older adults.

METHODS

Fifty-seven adults, whose average age was 71.5+/-7.5 years, were randomly assigned to an exercise (E), exercise-vitamin (EV), control (C) or vitamin (V) group, and were evaluated before, halfway through, and after training. The dose of vitamin E was 900 IU/day. The training program comprised three sessions of walking exercise per week, at an intensity of 70% of heart rate reserve.

RESULTS

In the E and EV groups, the training program significantly reduced (p<0.016 for each) body weight and body mass index (BMI), and improved performance in the 6- min walk, chair stand, arm curl, and back scratch tests. Performance on the 6-min walk test improved in E and EV, but decreased in the V group. Performance on the chair stand test increased in the EV and E groups, but decreased in the V and C groups. Body weight and BMI decreased more in the EV group than in the C and V groups (p<0.016).

CONCLUSIONS

Six months of vitamin E supplementation has no additive effect beyond that of aerobic training on indices of physical performance and body composition in older sedentary adults.

Atypical cyclopia in a brown swiss cross calf: a case report

In this report, an atypical form of cyclopia is described in a stillborn Brown Swiss cross male calf. The changes were confined to the head. The most significant malformation was the presence of a median orbita-like opening that did not contain an eyeball. Other defects included prosencephalic aplasia, brachygnathia superior and arrhinia. The possible cause of this congenital defect could not be ascertained.

Prevalence of low back pain in a developing urban setting

STUDY DESIGN

A cross-sectional survey was conducted using face-to-face interviews.

OBJECTIVES

To estimate the prevalence of low back pain (LBP) in an urban population of Turkey and to determine the factors associated with occurrence of LBP.

SUMMARY OF BACKGROUND DATA

Little information exists in the literature regarding the epidemiology of LBP in developing countries. A few data from previous studies suggest that the prevalence of LBP is rather lower in developing countries compared with developed countries.

METHODS

A total of 100 clusters of households (3,215 residents aged 16 years or older) in municipality area of Antalya was selected by systematic sampling. Of these, 3,173 study participants agreed to interview. The response rate was 98.7%.

RESULTS

The crude lifetime, 12-month, and point prevalences of LBP were 46.6% (95% confidence interval [CI], 44.9-48.3), 35.9% (95% CI, 34.2-37.6), and 20.1% (95% CI, 18.7-21.5), respectively. In logistic regression analysis, age of 36 years or older, female sex, multiparity, being a housewife, being from East Turkey, and smoking showed independent associations with having current LBP. Being religious, heavy smoking, and age 26 to 45 years were associated with having restricted activity related to LBP.

CONCLUSIONS

In comparison with other developing countries, point prevalence of LBP is higher in Turkey and approximates to prevalence estimates of LBP in developed countries. Smoking may be associated with both occurrence and severity of LBP. Although piety is not associated with having LBP, religious people are more likely to have restricted activity related to LBP.

The association of syndesmophytes with vertebral bone mineral density in patients with ankylosing spondylitis

OBJECTIVE

To determine bone mineral density (BMD) using the posteroanterior L2-L4 (PA) and lateral L3 (LAT-L3) projections of dual energy x-ray absorptiometry (DEXA) in patients with ankylosing spondylitis (AS), and to evaluate the relationship between BMD and the presence of syndesmophytes.

METHODS

Twenty men with AS were studied. BMD was measured by femoral neck DEXA, PA DEXA, and LAT-L3 DEXA scans. Radiographs of lumbar spine were evaluated to obtain a lumbar spine score (LSS) for the presence of syndesmophytes. Twenty-three age matched healthy men served as controls.

RESULTS

While there was no significant difference in BMD from PA DEXA results between AS patients and controls, BMD from the LAT-L3 DEXA was significantly reduced in AS patients (p = 0.009). LSS correlated significantly with BMD from PA DEXA (r = 0.55, p = 0.013), but not with BMD of LAT-L3 DEXA.

CONCLUSION

LAT-L3 DEXA was superior to PA DEXA in detecting a decrease of BMD in patients with AS. The presence of syndesmophytes had no distorting effect on BMD measured by LAT-L3 DEXA.

Prevalence of rheumatoid arthritis in Antalya, Turkey

The aim of this study was to evaluate the prevalence of rheumatoid arthritis (RA) in Antalya, Turkey. A cross-sectional study was performed face-to-face using a structured interview. Subjects were asked whether they had arthritis at present or previously. Subjects suspected of having RA were invited to the hospital for physical examination and laboratory investigations. Diagnosis of RA was confirmed if the patient fulfilled 1987 American College of Rheumatology (ACR) criteria for RA. A total of 3173 subjects were interviewed. The diagnosis of RA was established in 12 subjects. The prevalence of RA was determined as 0.38% [95% confidence interval (CI): 0.16-0.59]. The mean age was 49.92+/-11.56 years in subjects with RA and greater than that of other subjects (p<0.001). Of 12 subjects with RA, 9 had previously been diagnosed with the disease. Rheumatoid factor was detected in the sera of eight subjects. RA is less frequent in Turkey than in Northern Europe. Different genetic and environmental factors may have a role in this result.

The association of milk consumption with the occurrence of symptomatic knee osteoarthritis

OBJECTIVE

To evaluate the association of nutritional factors with symptomatic knee OA.

METHODS

This cross-sectional study was performed face-to-face using a structured interview. Individuals who had a diagnosis of symptomatic knee OA and were aged 50 years or over were included in this study. The frequency of consumption of dairy products, meat/poultry, fish, cereals, vegetables, tea and coffee were also determined. The diagnosis of knee OA was made clinically or clinically and radiologically according to the ACR criteria for knee OA.

RESULTS

A total of 655 subjects was interviewed. The frequency of symptomatic knee OA was significantly lower in daily milk consumers (p < 0.05). Tea consumption was also inversely associated with symptomatic knee OA (p < 0.05), although other nutritional elements showed no significant relationship with OA.

CONCLUSION

Milk consumption may have beneficial effects on symptomatic knee OA.

The prevalence of symptomatic knee and distal interphalangeal joint osteoarthritis in the urban population of Antalya, Turkey

The aim of this cross-sectional study was to estimate the prevalence and risk factors of symptomatic knee and distal interphalangeal (DIP) joint osteoarthritis (OA) in the elderly (> or =50 years of age) urban population of Antalya, Turkey. According to the 1997 national census, Antalya's population was 508,840. By random cluster sampling, 655 individuals aged 50 years or more were interviewed face-to-face and subjected to structured interviews regarding knee pain, worsening pain on exertion, and the gelling phenomenon. They were also asked about performing namaz (a fundamental act of worship in Islam performed five times a day), smoking, type of residence, type of toilet, work style, and duration of walking per day. They were also questioned about swelling in DIP joints. In the case of suspicion of knee OA, the individuals were invited to the hospital for further evaluation by physical examination and direct roentgenogram. The diagnosis of knee OA was based on clinical or clinical and radiographic findings. The prevalence of symptomatic knee OA was determined as 14.8% in the population aged 50 years or over. Advanced age, female sex, namaz, and type of residence were found to be associated with knee OA. The rate of symptomatic knee OA was significantly lower in smokers and those walking more than 2 h per day. Female sex was also strongly associated with OA DIP joints. OA of DIP joints was found significantly associated with symptomatic knee OA. The latter is a major health problem in the elderly population, especially in about one fourth of women aged 50 years or over. These data suggest that advanced age, female sex, and type of residence are risk factors.

Quantitative sacroiliac joint scintigraphy in normal subjects and patients with sacroiliitis

The aim of this study is to determine the sacroiliac index (SII) of healthy subjects and to compare these values with patients having sacroiliitis (SI). Quantitative sacroiliac scintigraphy (QSS) was performed with Tc-99m hydroxy methylene diphosphonate (HMDP) and whole sacroiliac joint-to-sacrum ratio was calculated as a SII by the region of interest (ROI) method. Forty-seven nonarthritic healthy subjects and 13 patients with SI were studied. Effects of aging, gender and laterality on SII were evaluated in 47 healthy subjects. The sacroiliac index was higher in men than women (p < 0.05). SII did not change significantly in aged men, but it decreased significantly in aged women (p < 0.05). Eleven of 13 patients with SI had a higher SII than healthy subjects (> mean + 2SD). In the other two cases by using small ROIs, SIIs were found to be higher than the normal range. Our results suggest that QSS is a sensitive method for the diagnosis of early stage SI and every institution should establish its own normal SII.