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Assessment of the Relationship Between Bone Mineral Density and Disease Activity in Ankylosing Spondylitis Patients with Osteopenia
(Galenos Yayincilik, 2013) Guler, Hayal; Ustun, Nilgun; Bolac, Veli Enes; Yagiz, Abdullah Erman; Mansuroglu, Ayhan; Yengil, Erhan; Turhanoglu, Ayse Dicle
Aim: Ankylosing Spondylitis (AS) is a chronic inflammatory disease. Spinal osteopenia is common in AS, probably due to immobility and local cytokine release. In this study, we evaluated the relationship between bone mineral density and disease activity in Ankylosing Spondylitis patients with osteopenia. Material and Methods: Sixty one AS patients (26F, 35M) were enrolled in this study. The disease duration, morning stiffness, Schober tests, Erythrocyte Sedimentation Rate (ESR) and C Reactive Protein (CRP) were analyzed and recorded. Disease activity was evaluated by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Bone mineral density (BMD) was measured by using GE/LUNAR DPX PRO equipment. Results: The mean age and disease duration of the patients were 38.67 +/- 10.81 and 7.87 +/- 7.09 year. There was osteopenia in 34 (% 55.7) patients. Spine and femur BMD values of this patients were 1.03 +/- 0.16 and 0.88 +/- 0.09. BMD measurements of 27 (% 44.3) patient were found normally. Spine and femur BMD values of this patients were 1.20 +/- 0.11 and 1.11 +/- 0.15. There was not statistically significant difference between osteopenia and normal group in ESR, CRP, and BASDAI values (p>0.05). There was not correlation between BMD values and ESR, CRP, and BASDAI values in osteopenia group (p>0.05). Conclusion: In our study, we did not find relationship between bone mineral density and disease activity in AS patients with osteopenia.
Assessment of the Relationship between Physical Activity Levels and Isokinetic Muscle Performance
(Galenos Yayincilik, 2016) Micoogullari, Ahmet; Yildizgoren, Mustafa Turgut; Turhanoglu, Ayse Dicle; Ustun, Nilgun; Guler, Hayal
Objective: To evaluate the association between physical activity levels and isokinetic muscle strength of knee. Materials and Methods: Thirty amateur athletes and 30 healthy volunters (aged between 20-24) were included in the study. Participants were divided into two groups as amateur athletes (group 1) and healthy controls (group 2). Physical activity levels of the participants were assessed by International Physical Activity Questionnaire (IPAQ). Dominant knee flexion and extension muscle strength of the participants were measured with an isokinetic dynamometer at 60 degrees/s and 180 degrees/s angular velocities. Results: There were no statistically significant difference between the groups in age, sex, weight, height, body mass index and, smoking status (p>0.05). There was a statistically significant difference in IPA scores between the groups (p<0.05). IPAQ scores were higher in group1I. There were no statistically significant difference between the knee extensor and flexor peak torque values in both groups (p>0.05). Group 1 was divided into subgroups according to IPA scores. In patients with high activity level, peak torque values at the angular velocities of 60 degrees/s and 180 degrees/s for knee muscles were significiantly higher (p<0.05). Conclusion: Further studies that evaluating of the many factors that determining and affecting muscle strength are with larger groups will be beneficial.
Cervical vertebral osteophyte as a rare cause of dysphagia: a report of three cases
(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2015) Yetim, Tulin Durgun; Karabacak, Yasemin Bilgin; Bayarogulan, Hanifi; Sengul, Aysen Taslak; Ustun, Nilgun
Diffuse idiopathic skeletal hyperostosis (ankylosing hyperostosis, Forestier's disease, spondylitis ossificans ligamentosa) is a chronic disease characterized by the widespread spinal osteofit formation due to enchondral ossification of paravertebral ligament and muscles. Treatment is primarily based on dietary changes and anti-inflammatory therapy in diffuse idiopathic skeletal hyperostosis patients suffering from dysphagia. Surgery should be considered in patients with a severe clinical status. In this article, we report three patients and discuss the diagnosis and treatment in the light of literature.
Conservative Treatment of Achilles Tendinosis, and Importance of Ultrasonography in The Follow-Up: A Case Report
(Galenos Yayincilik, 2015) Yildizgoren, Mustafa Turgut; Osmanoglu, Kasim; Ustun, Nilgun; Guler, Hayal; Turhanoglu, Ayse Dicle
Achilles tendinopathy is a painful condition that often develops as a result of overloading to tendon. There are many factors in etiology like tendon ischemia, micro-tears and metabolic events. Non-insertional tendon region of the Achilles tendon that has poor vascularity is a common localization for tendinopathy. In this paper, we presented a 55 year old man, who had pain and swelling in the right heel and we discussed the importance of ultrasound.
Efficacy of EMLA cream phonophoresis comparison with ultrasound therapy on myofascial pain syndrome of the trapezius: a single-blind, randomized clinical study
(Springer Heidelberg, 2014) Ustun, Nilgun; Arslan, Fatma; Mansuroglu, Ayhan; Inanoglu, Deniz; Yagiz, Abdullah Erman; Guler, Hayal; Turhanoglu, Ayse Dicle
The aim of this study is to investigate whether eutectic mixture of local anesthetics (EMLA) cream phonophoresis superior to conventional US over the trigger points (TPs) in terms of improvements of pain, range of motion and disability in myofascial pain syndrome (MPS). Fifty patients (42 female, 8 male) diagnosed with MPS were included in the study. Patients were randomly assigned into two treatment groups including phonophoresis (PH) group (n = 25) and ultrasound (US) group (n = 25). PH group received EMLA cream phonophoresis (2.5 % lidocaine, 2.5 % prilocaine); US group received conventional ultrasound therapy over the all active TPs on trapezius muscle for 10 min a day for 15 sessions. Outcome measures were performed before the treatment course and at the end of a 15-session course of treatment. Student T, Mann-Whitney U, chi-square and Wilcoxon tests were used for statistical analysis. At the end of the therapy, there was statistically significant decrease in both PH group and US group in terms of number of trigger point (NTP) (p = 0.001, p = 0.029), pain intensity on movement (p = 0.001 vs. 0.002) and right/left cervical lateral ROMs (p = 0.001/p = 0.001, p = 0.009/p = 0.020) relative to baseline. The NTP decrease in PH group was significantly higher than that in US group (1.84 +/- A 1.46 vs. 0.72 +/- A 1.45; p = 0.01). Pain intensity at rest (p = 0.001) and NPDI scores (p = 0.001) were statistically improvement in only PH group. EMLA cream phonophoresis is more effective than conventional ultrasound therapy in terms of pain and associated neck disability, and it seems the complementary treatment option for MPS.
Increased Epicardial Fat Tissue Is a Marker of Subclinic Atherosclerosis in Ankylosing Spondylitis
(Turkish League Against Rheumatism, 2014) Ustun, Nilgun; Kurt, Mustafa; Atci, Nesrin; Yagiz, Erman; Guler, Hayal; Turhanoglu, Ayse
Objectives: This study aims to assess subclinical atherosclerosis markers such as epicardial fat thickness, carotid intima media thickness (CIMT), and aortic stiffness index (ASI) in ankylosing spondylitis (AS) patients as well as to investigate the relationship between the subclinical atherosclerosis markers and disease activity/function/mobility indices. Patients and methods: Twenty-six AS patients (22 males, 4 females; mean age 43 years) and 26 age-and sex-matched healthy controls (21 males, 5 females; mean age 43 years) were included. Patients and controls with any reported cardiovascular disease or other comorbidities were excluded. Disease activity, functional capacity and spinal mobility were measured using the Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, and Bath Ankylosing Spondylitis Metrology Index, respectively. All patients underwent complete transthoracic echocardiographic examination including epicardial fat thickness and ASI, and sonographic examination including CIMT. Results: There were no significant differences in demographical and cardiovascular characteristics between AS patients and healthy controls (p>0.05). Epicardial fat thickness (5.15 +/- 1.13 vs. 4.11 +/- 1.22; p=0.003), CIMT (0.70 +/- 0.16 vs. 0.60 +/- 0.10; p=0.012) and ASI (14.2 +/- 10.8 vs. 8.6 +/- 3.1; p=0.018) were significantly increased in patients with AS compared to the healthy controls. There was no significant correlation between the subclinical atherosclerosis markers and disease activity/function/mobility indices (p>0.05). Conclusion: A significantly increased epicardial fat thickness, CIMT, and ASI were observed in AS patients compared with healthy controls.
Left ventricular systolic dysfunction in patients with ankylosing spondylitis without clinically overt cardiovascular disease by speckle tracking echocardiography
(Springer Heidelberg, 2015) Ustun, Nilgun; Kurt, Mustafa; Nacar, Alper Bugra; Karateke, Hacer Paksoy; Guler, Hayal; Turhanoglu, Ayse Dicle
The aim of this study was to evaluate left ventricular systolic and diastolic function using speckle tracking echocardiography (STE) in order to detect subclinical left ventricular dysfunction in patients with ankylosing spondylitis (AS). Twenty-six AS patients (age 43.7 +/- A 11.8 years, disease duration 11.83 +/- A 10.98 years) and 26 healthy controls, matched for age, sex, body mass index, and smoking, were enrolled in this cross-sectional study. All patients underwent two-dimensional, Doppler, tissue Doppler, and speckle tracking echocardiography. The mitral early/late diastolic inflow velocity ratio (1.0 +/- A 0.4 vs. 1.5 +/- A 0.5; p < 0.001) and the mitral E-wave velocity (8.1 +/- A 2 vs. 11.1 +/- A 3; p < 0.001) were lower in the AS patients than in the controls. The ejection fraction did not differ between the patients and controls (64 +/- A 4.2 vs. 64.8 +/- A 2.3; p = 0.402). All segments showed a significant decrease in left ventricular diastolic and systolic strain values in the patients with AS when compared with the healthy controls (p < 0.001). Despite no clinical evidence of cardiovascular disease, patients with AS may have impaired left ventricular systolic function as assessed by STE.
Mean Platelet Volume in Children with Familial Mediterranean Fever and the Relationship with Attack Status, Colchicine Treatment and Gene Mutation
(Modestum Ltd, 2014) Ustun, Nilgun; Ulasli, Alper Murat; Celik, Tanju; Yula, Erkan; Turhanoglu, Ayse Dicle
Increased mean platelet volume (MPV) is a manifestation of platelet functions and activation, and accepted as a prognostic biomarker in patients with cardiovascular disease. We aimed to investigate MPV levels in pediatric Famillial Mediterranean Fever (FMF) patients during the attack and attack-free periods, and the effect of colchicine treatment and presence of M694V mutation. Thirty-five pediatric patients with FMF and 38 age-sex-matched healty controls were enrolled retrospectively into the study. Of the patients 11 (31%) had an ongoing attack, and 24 (69%) were in attack-free period. 26 (74%) patients were receiving colchicine and 16 (45.7%) had M694V gene mutation. There was no significant difference in platelet (PLT) and MPV between patients and healthy controls (p=0.196 and p=0.167 respectively). Mean PLT and MPV values of the patients during attack and attack-free period were also not significantly different (p=0.355 and p=0.118 respectively). However, MPV levels during an FMF attack were non-significantly lower than healthy control group (p=0.08). PLT and MPV levels were higher in patients receiving colchicine but the differences were not significant (p=0.097 and p=0.446 respectively). Mean MPV value of the FMF patients with M694V mutation was not significantly different than controls (p=0.773). In conclusion, this study reveals that pediatric FMF patients have similar MPV levels with healthy individuals even in the presence of M694V mutation. MPV as an early atherosclerosis marker, is not significantly elevated in this patient cohort. Regular treatment with colchicine and younger age may have a role in non-impaired platelet activation in FMF patients.
Predictors of Difficult Intubation in Patients With Ankylosing Spondylitis: Do Disease Activity and Spinal Mobility Indices Matter?
(Turkish League Against Rheumatism, 2014) Ustun, Nilgun; Tok, Fatih; Davarci, Isil; Yagiz, Erman; Guler, Hayal; Turhanoglu, Selim; Turhanoglu, Ayse
Objectives: This study aims to determine the predictors of difficult intubation and their possible correlations with disease activity and spinal mobility indices in patients with ankylosing spondylitis. Patients and methods: Forty-five ankylosing spondylitis patients were included in the study. Disease activity was evaluated with the Bath Ankylosing Spondylitis Disease Activity Index and spinal mobility with Bath Ankylosing Spondylitis Metrology Index (BASMI). The predictors of difficult intubation were evaluated by using the modified Mallampati test, upper lip bite test, thyromental distance, sternomental distance, interincisor distance and neck extension. Results: There was no correlation between Bath Ankylosing Spondylitis Disease Activity Index and predictive test values (all p>0.05). There were significant correlations between BASMI with modified Mallampati test, sternomental distance, neck extension, and inter-incisor distance values (all p<0.05). The BASMI scores in patients with two or more predictors were significantly higher than BASMI scores in patients with none or one predictor (5.28 +/- 2.12 vs. 1.58 +/- 1.50; p<0.001). Among the patients with moderate to severe BASMI, the number of patients with two or more predictors was higher than in those patients with none or one predictor (p=0.001). Conclusion: Neck extension, inter-incisor distance, sternomental distance and modified Mallampati test are significant predictors for difficult intubation in patients with ankylosing spondylitis. These predictors were found to be correlated with spinal mobility index, but not with disease activity index. Clinicians should be aware of difficult intubation in ankylosing spondylitis patients with moderate to severe spinal mobility limitation.
Relationship between erector spinae muscle thickness and bone mineral density in postmenopausal women: An ultrasonographic study
(A. CARBONE Editore, 2016) Guler, Hayal; Yildizgoren, Mustafa Turgut; Ustun, Nilgun; Karazincir, Sinem; Balcı, Ali; Ozer, Cahit; Turhanoglu, Ayse Dicle
Introduction: Aging is associated with an increase in the risk of falls and fractures in elderly osteoporotic women in addition to low bone mass and muscle atrophy. We aimed to assess relationship between paraspinal muscle thickness and bone mineral density in postmenopausal women. Materials and methods: Overall, 95 postmenopausal women were included into the study. Back pain was assessed by using Numeric Rating Scale (NRS). Bone mineral density (BMD) was measured with dual-energy X-ray absorptiometry (DXA) at the lumbar spine and femoral neck. Postmenopausal women were classified into 3 groups as osteopenia, osteoporosis and normal BMD according to WHO. Quality of life was assessed by using Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41). Paraspinal muscle thickness was measured from 4 cm lateral to midline by sonography at the level of the 10th thoracic spine. Results: No significant difference was detected between groups regarding duration of weekly exercises, back pain (NRS) and QUALEFFO values (p > 0.05). In the osteoporosis group, mean muscle thickness was found to be lower in both right and left side when compared to those in osteopenia and normal BMD group (p < 0.01). In addition, mean muscle thickness was found to be lower in both right and left side in osteopenia when compared to normal BMD group (p < 0.01). Conclusion: Our study indicates that reduction in bone mass is related to decrease in muscle mass.
RELATIONSHIP BETWEEN ERECTOR SPINAE MUSCLE THICKNESS AND BONE MINERAL DENSITY IN POSTMENOPAUSAL WOMEN: AN ULTRASONOGRAPHIC STUDY
(Carbone Editore, 2016) Guler, Hayal; Yildizgoren, Mustafa Turgut; Ustun, Nilgun; Karazincir, Sinem; Balcı, Ali; Ozer, Cahit; Turhanoglu, Ayse Dicle
Introduction: Aging is associated with an increase in the risk of falls and fractures in elderly osteoporotic women in addition to low bone mass and muscle atrophy. We aimed to assess relationship between paraspinal muscle thickness and bone mineral den shy in postmenopausal women. Materials and methods: Overall, 95 postmenopausal women were included into the study. Back pain was assessed by using Numeric Rating Scale (NRS). Bone mineral density (BMD) was measured with dual-energy X-ray absorptiometry (DXA) at the lumbar spine and femoral neck. Postmenopausal women were classified into 3 groups as osteopenia, osteoporosis and normal BMD according to WHO. Quality of life was assessed by using Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41). Paraspinal muscle thickness was measured from 4 cm lateral to midline by sonography at the level of the 10th thoracic spine. Results: No significant difference was detected between groups regarding duration of weekly exercises, back pain (NRS) and QUALEFFO values (p>0.05). In the osteoporosis group, mean muscle thickness was found to be lower in both right and left side when compared to those in osteopenia and normal BMD group (p<0.01). In addition, mean muscle thickness was found to be lower in both right and left side in osteopenia when compared to normal BMD group (p<0.01). Conclusion: Our study indicates that reduction in bone mass is related to decrease in muscle mass.
The Seropositivity of Parvovirus B19 in Patients with Ankylosing Spondylitis
(Aves, 2014) Motor, Vicdan Koksaldi; Ustun, Nilgun; Evirgen, Omer; Inci, Melek; Yula, Erkan; Onlen, Yusuf
Objective: Parvovirus B19 is one of the most common causes of viral arthritis, which suggests that it can be a significant factor in the pathogenesis of chronic inflammatory diseases, such as rheumatoid arthritis. The aim of the present study was to investigate the seropositivity of parvovirus B19 in patients with ankylosing spondylitis (AS). Material and Methods: The patient group consisted of 43 patients with ankylosing spondylitis; the control group consisted of 70 subjects who did not have any bone joints complaints. Anti-parvovirus B19 IgM and IgG antibodies were measured by ELISA. Results: Parvovirus B19 IgM antibody positivity in patients with AS was significantly higher than that in the control group (p<0.001). Conclusion: The high frequency of anti-parvovirus B19 IgM positivity in patients with AS suggests that the virus reactivates or persists in these patients due to immuno deficiency.
Ultrasonographic Assessment of the Distal Femoral Cartilage Thickness in Patients with Homozygous Sickle Cell Disease
(Sage Publications Inc, 2016) Yildizgoren, Mustafa Turgut; Helvaci, Mehmet Rami; Ustun, Nilgun; Osmanoglu, Kasim; Turhanoglu, Ayse Dicle
Objective. To compare the distal femoral cartilage thickness of patients with sickle cell disease (SCD) with those of healthy subjects using ultrasonography. Methods. The study comprised 30 patients with SCD (16 male, 14 female; mean age, 30.1 years) and 30 age-and sex-matched healthy subjects. Demographic features and medications of the patients were recorded. With the knees held in maximum flexion, the femoral cartilage thickness was measured bilaterally with a 7- to 12-MHz linear probe. Using ultrasonography, 3 midpoint measurements were taken from both knees: lateral femoral condyle (LFC), intercondylar area (ICA), and medial femoral condyle (MFC). Results. Patients with SCD had thinner femoral cartilage thickness values at LFC (P = 0.004), at MFC (P = 0.000), and ICA (P = 0.002) when compared with those of the healthy subjects. Patients with SCD also had lower Hb levels (P = 0.000) levels. Weak positive correlations were determined between Hemoglobin (Hb) levels and ultrasonographic measurements in the SCD group at MFC (r = 0.331, P = 0.010), and ICA (r = 0.289, P = 0.025). Low levels of Hb seem to affect the femoral cartilage thickness. Conclusion. These preliminary findings of decreased femoral cartilage thickness in SCD patients should be complemented with future studies. The possibility of early knee joint degeneration and eventual osteoarthritis in SCD should be kept in mind.
Ultrasound-Guided vs. Blind Steroid Injections in Carpal Tunnel Syndrome A Single-Blind Randomized Prospective Study
(Lippincott Williams & Wilkins, 2013) Ustun, Nilgun; Tok, Fatih; Yagiz, Abdullah Erman; Kizil, Nurhan; Korkmaz, Inan; Karazincir, Sinem; Okuyucu, Esra
Objective: The aim of this study was to compare the efficacy and the safety of ultrasound (US)-guided vs. blind steroid injections in patients with carpal tunnel syndrome (CTS). Design: This prospective randomized single-blind clinical trial included 46 patients with CTS (46 affected median nerves). The subjects were randomized-to either the US-guided or the blind injection group-before they received 40 mg of methylprednisolone. They were evaluated using the Boston Carpal Tunnel Questionnaire symptom/function at baseline and at 6 wks and 12 wks after injection, and the side effects were noted. Results: The symptom severity and functional status scores improved significantly in both groups at 6 wks after treatment, and these improvements persisted at 12 wks after treatment (all P < 0.05). The improvement in symptom severity scores in the US-guided group at 12 wks was higher than in the palpation-guided group (P < 0.05). Average time to symptom relief was shorter in the US-guided group (P < 0.05). There was no significant difference between the two groups in terms of side effects (P > 0.05). Conclusions: Although both US-guided and blind steroid injections were effective in reducing the symptoms of CTS and improving the function, an earlier onset/better improvement of symptom relief suggests that US-guided steroid injection may be more effective than are blind injections in CTS.

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