Burcu Ortanca

Background and Objectives: The aim was to evaluate nerve healing using immunohistochemical, histological, and functional techniques and to compare the effects of two different therapeutic ozone application methods by perineural and intraperitoneal ozone treatment in rats with a crush injury model of sciatic nerve. Materials and Methods: Forty male Sprague Dawley rats were divided into four subgroups of ten rats each: (1) Control group: The left sciatic nerve incised and closed without crush injury, no treatment; (2) Paralyzed group: Crush injury to the left sciatic nerve, no treatment; (3) Perineural ozone group: Crush injury to the left sciatic nerve, treated with perineural ozone therapy; (4) Intraperitoneal ozone group: Crush injury to the left sciatic nerve, treated with intraperitoneal ozone therapy. The treatments were administered for a 14-day period. Hematoxylin and eosin (H&E) and toluidine blue staining were used for histological examination; TUNEL staining was used for immunohistochemical examination. Pinch test and rotarod performance assessment were utilized for functional evaluation. Results: The pinch test scores showed significant improvement in perineural and intraperitoneal ozone treatment groups after treatment (p < 0.001 and p = 0.003, respectively). The scores of myelin degeneration, vascular congestion, vascular wall thickness, inflammation, and toluidine blue and TUNEL staining were significantly lower in both ozone treatment groups compared to the paralyzed group (p < 0.001). Vascular wall thickness scores were significantly higher in the perineural ozone group compared to the control and intraperitoneal ozone groups (p = 0.004 and p = 0.013, respectively). The Schwann cell proliferation scores were significantly higher in the perineural ozone group compared to the control group and intraperitoneal ozone groups (p < 0.001). Conclusions: Both applications of ozone therapy accelerated the healing of nerve regeneration, reduced inflammation and apoptosis based on histopathological results, and enhanced nerve function in rats with sciatic nerve injury. Perineural ozone therapy has been demonstrated to be an efficacious alternative to systemic ozone treatments in the management of sciatic nerve injury. Further studies are needed to determine optimal ozone dosage and administration protocols for the treatment of nerve injury.

Background and Objectives: There is a lack of studies examining balance problems and Achilles tendon thickness in prediabetes despite their common occurrence in diabetes mellitus. The aim of this study was to evaluate Achilles tendon size and static and dynamic balance, as well as the role of the Achilles tendon in balance, in prediabetic patients. Materials and Methods: A total of 96 participants were divided into three groups: (1) the control group, consisting of participants without diabetes mellitus; (2) the prediabetes group; and (3) the diabetes mellitus group. Ultrasonographic measurements of Achilles tendon sizes (thickness, width and area) were performed. Dynamic balance was assessed using the Berg Balance Scale, and static balance (the Fall and Stability Indices) was assessed using a Tetrax device. The Self-Leeds Assessment of Neuropathic Symptoms and Signs was utilized to identify neuropathic pain. Results: In the prediabetes group, the median dynamic balance scores [54.0 (51.0–56.0)] were lower than those of the control group [55.0 (54.0–56.0)] but higher than those of the patients with diabetes mellitus [52.50 (49.0–54.25)]; however, this difference did not reach statistical significance. The ultrasonographic measurements of the Achilles tendon size were similar among the three groups. On the other hand, in the prediabetes group, a positive correlation was observed between the bilateral Achilles tendon anterior–posterior thickness and Fall Index score (p = 0.045), while a negative correlation was found between the left Achilles tendon anterior–posterior thickness and the Berg Balance Score (p = 0.045). Conclusions: In prediabetes, neither Achilles tendon size nor static or dynamic balance appears to be significantly affected. However, in prediabetic patients, increased Achilles tendon thickness appears to be associated with increased risk of falls and decreased balance.

Introduction: We aimed to investigate whether the rate of sarcopenia is higher in patients with pseudoexfoliation syndrome and if an association exists between pseudoexfoliation syndrome, sarcopenia parameters, and chronic musculoskeletal pain. Materials and Method: A total of 96 enrolled patients were divided into two equal groups: “pseudoexfoliation syndrome group” and “no pseudoexfoliation syndrome group”. The variables were demographic characteristics, sarcopenia parameters (SARC-F, hand-grip strength, chair-rise test, gait speed), and pain parameters (having any chronic musculoskeletal pain, pain regions, and Visual Analog Scale-pain). Results: Comparison of sarcopenia and pain parameters between the two groups showed that SARC-F (all groups:p<0.001, 65-74 years:p<0,001, 75-84 years:p=0,015), chair rise test (all groups:p<0.001, 65-74 years:p=0,002, 75-84 years:p=0,003), and Visual Analog Scale-pain (all groups:p<0.001, 65-74 years:p=0,007, 75-84 years:p=0,003) scores were statistically significantly higher, while the gait speed (all groups:p<0.001, 65-74 years:p=0,004, 75-84 years:p=0,007) score was significantly lower in “pseudoexfoliation syndrome group” than in “no pseudoexfoliation syndrome group”. 60.4% of patients with pseudoexfoliation syndrome had probable sarcopenia, and 83% had chronic musculoskeletal pain. A comparison of the two groups showed that the rate of sarcopenia (all groups:p<0.001, 65-74 years:p<0,001, 75-84 years: p=0,014) and the rate of having chronic musculoskeletal pain (all groups, 75-84 years: p=0.002) was significantly higher in patients with pseudoexfoliation syndrome. Conclusion: Our study results showed that most patients with pseudoexfoliation syndrome had chronic musculoskeletal pain and probable sarcopenia. Although pseudoexfoliation syndrome and sarcopenia are problems of aging, further research is needed to explain the pathogenetic mechanisms underlying the high rate of sarcopenia and chronic pain in patients with pseudoexfoliation syndrome. ClinicalTrials.gov Identifier: NCT06121154 Keywords: Chronic Pain; Exfoliation Syndrome; Sarcopenia.

Neuropathic arthropathy is a chronic degenerative arthropathy that results from a neurosensory deficit of the affected joint. According to neurovascular theory, the loss of sensation of the joint is responsible for its formation. Chronic inflammatory demyelination polyneuropathy (CIDP) is a rare disease with sensorimotor involvement in which demyelination and axonal damage occur in the peripheral nerves as a result of an abnormal immune response. A case is presented of a 64-year-old male patient with a diagnosis of CIDP who had Charcot arthropathy of the right shoulder. '+st+' ¹ Department of Physical Medicine and Rehabilitation, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey ¹Department of Physical Medicine and Rehabilitation, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey Jones EA, Manaster BJ, May DA, Disler DG. Neuropathic osteoarthropathy: diagnostic dilemmas and differential diagnosis. Radiographics. 2000 Oct;20 Spec No:S279-93. doi: 10.1148/radiographics.20.suppl_1.g00oc22s279. DOI: https://doi.org/10.1148/radiographics.20.suppl_1.g00oc22s279 Xu DY, Cao LB, Liu C, Zhan AL, Feng WH. Neuroarthropathy. Clinico-radiologic analysis of 115 cases. Chin Med J (Engl). 1992 Oct;105(10):860-5. Alpert SW, Koval KJ, Zuckerman JD. Neuropathic Arthropathy: Review of Current Knowledge. J Am Acad Orthop Surg. 1996 Mar;4(2):100-8. doi: 10.5435/00124635-199603000-00005. DOI: https://doi.org/10.5435/00124635-199603000-00005 Yanik B, Tuncer S, Seçkin B. Neuropathic arthropathy caused by Arnold-Chiari malformation with syringomyelia. Rheumatol Int. 2004 Jul;24(4):238-41. doi: 10.1007/s00296-003-0389-x. DOI: https://doi.org/10.1007/s00296-003-0389-x Mathey EK, Park SB, Hughes RA, Pollard JD, Armati PJ, Barnett MH, Taylor BV, Dyck PJ, Kiernan MC, Lin CS. Chronic inflammatory demyelinating polyradiculoneuropathy: from pathology to phenotype. J Neurol Neurosurg Psychiatry. 2015 Sep;86(9):973-85. doi: 10.1136/jnnp-2014-309697. DOI: https://doi.org/10.1136/jnnp-2014-309697 Broers MC, Bunschoten C, Nieboer D, Lingsma HF, Jacobs BC. Incidence and Prevalence of Chronic Inflammatory Demyelinating Polyradiculoneuropathy: A Systematic Review and Meta-Analysis. Neuroepidemiology. 2019;52(3-4):161-72. doi: 10.1159/000494291. DOI: https://doi.org/10.1159/000494291 Van den Bergh PY, Hadden RD, Bouche P, Cornblath DR, Hahn A, Illa I, et al. European Federation of Neurological Societies/Peripheral Nerve Society guideline on management of chronic inflammatory demyelinating polyradiculoneuropathy: report of a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society-first revision. Eur J Neurol. 2010 Mar;17(3):356-63. doi: 10.1111/j.1468-1331.2009.02930.x. DOI: https://doi.org/10.1111/j.1468-1331.2009.02930.x Bromberg MB. What is in the Literature. J Clin Neuromuscul Dis. 2021 Jun 1;22(4):200-8. doi: 10.1097/CND.0000000000000371. DOI: https://doi.org/10.1097/CND.0000000000000371 Snoddy MC, Lee DH, Kuhn JE. Charcot shoulder and elbow: a review of the literature and update on treatment. J Shoulder Elbow Surg. 2017 Mar;26(3):544-52. doi: 10.1016/j.jse.2016.10.015. DOI: https://doi.org/10.1016/j.jse.2016.10.015 Eichenholtz SN. Charcot joints. Springfield, IL: Charles C Thomas; 1966. Brower AC, Allman RM. Pathogenesis of the neurotrophic joint: neurotraumatic vs. neurovascular. Radiology. 1981 May;139(2):349-54. doi: 10.1148/radiology.139.2.7220879. DOI: https://doi.org/10.1148/radiology.139.2.7220879 Rickert MM, Cannon JG, Kirkpatrick JS. Neuropathic Arthropathy of the Shoulder: A Systematic Review of Classifications and Treatments. JBJS Rev. 2019 Oct;7(10):e1. doi: 10.2106/JBJS.RVW.18.00155. DOI: https://doi.org/10.2106/JBJS.RVW.18.00155 Kenan S, Lewis MM, Main WK, Hermann G, Abdelwahab IF. Neuropathic arthropathy of the shoulder mimicking soft tissue sarcoma. Orthopedics. 1993 Oct;16(10):1133-6. doi: 10.3928/0147-7447-19931001-09. DOI: https://doi.org/10.3928/0147-7447-19931001-09 Norman A, Robbins H, Milgram JE. The acute neuropathic arthropathy--a rapid, severely disorganizing form of arthritis. Radiology. 1968 Jun;90(6):1159-64. doi: 10.1148/90.6.1159. DOI: https://doi.org/10.1148/90.6.1159 Sackellares JC, Swift TR. Shoulder enlargement as the presenting sign in syringomyelia. Report of two cases and review of the literature. JAMA. 1976 Dec 20;236(25):2878-9. DOI: https://doi.org/10.1001/jama.236.25.2878 Copyright (c) 2023 Burcu Ortanca, Onur Armağan, Mazlum Doğan Bilici This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Background/Aim: Considering the effects of inflammation on fibromyalgia and the small intestine, we hypothesize that vitamin D deficiency may contribute to inflammation and affect vitamin B12 and ferritin levels in patients with fibromyalgia. The objectives were: 1) to compare the levels of vitamin D, vitamin B12, and ferritin in patients with fibromyalgia and patients who have local painful conditions, and 2) to evaluate the correlation of vitamin D levels with vitamin B12 and ferritin levels. Methods: The records of 299 patients with fibromyalgia (274 female, 25 male) and 128 patients with local painful conditions (114 female, 14 male) between April 2019 and 2020 were examined, including measurements of 25-hydroxy vitamin D, vitamin B12, ferritin, erythrocyte sedimentation rate, and C-reactive protein. Results: The levels of 25-hydroxy vitamin D were low in both groups, with levels below 30 ng/ml in 90.3% of all patients. However, there was no significant difference in vitamin B12 and ferritin levels between the two groups, and the levels of these markers were within normal limits in both groups. Correlation analysis showed that vitamin D levels were significantly correlated with vitamin B12 (P<0.001, r=0.211) and ferritin (P=0.005, r=0.337) levels in patients with fibromyalgia but not in the other group. Conclusion: Consistent with our hypothesis, an association was found between vitamin D levels and vitamin B12 and ferritin levels in fibromyalgia. However, this correlation was not found in patients with local painful conditions. '+st+' Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis Rheum. 1990;33(2):160-72. doi: 10.1002/art.1780330203 DOI: https://doi.org/10.1002/art.1780330203 Arranz L, Canela M, Rafecas M. Fibromyalgia and nutrition, what do we know? 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Serum levels of vitamin B12 (cobalamin) in fibromyalgia. Rheumatology international. 2016;36(5):741-2. doi: 10.1007/s00296-016-3454-y DOI: https://doi.org/10.1007/s00296-016-3454-y Akar N, Çaglar NS, Aytekin E, Akar A, Aksu Ö, Öz N. Low levels of serum vitamin D3 are associated with fibromyalgia syndrome in pre-menopausal women: A pilot study. Turk J Phys Med Rehabil. 2020;66(1):67-72. doi: 10.3906/sag-1508-30 DOI: https://doi.org/10.5606/tftrd.2020.2928 Ozcan DS, Oken O, Aras M, Koseoglu BF. Vitamin D levels in women with fibromyalgia and relationship between pain, depression, and sleep. Turk J Phys Med Rehabil. 2014;60(4):329-35. doi: 10.5152/tftrd.2014.45143 DOI: https://doi.org/10.5152/tftrd.2014.45143 Özgen M, Aydoğan AM, Uygur A, Armağan O, Berkan F, Mutlu F. Fibromiyalji Sendromunda D Vitamin Düzeylerinin Değerlendirilmesi. OJM. 2018;41(2):161-5. doi: 10.20515/otd.459018 DOI: https://doi.org/10.20515/otd.459018 Backryd E, Tanum L, Lind AL, Larsson A, Gordh T. Evidence of both systemic inflammation and neuroinflammation in fibromyalgia patients, as assessed by a multiplex protein panel applied to the cerebrospinal fluid and to plasma. J Pain Res. 2017;10:515–25. doi: 10.2147/JPR.S128508 DOI: https://doi.org/10.2147/JPR.S128508 Rodriguez-Pinto I, Agmon-Levin N, Howard A, Shoenfeld Y. Fibromyalgia and cytokines. Immunol Lett. 2014;161(2):200–3. doi: 10.1016/j.imlet.2014.01.009 DOI: https://doi.org/10.1016/j.imlet.2014.01.009 Russell IJ, Orr MD, Littman B, Vipraio GA, Alboukrek D, Michalek JE, et al. Elevated cerebrospinal fluid levels of substance P in patients with the fibromyalgia syndrome. Arthritis Rheum. 1994;37(11):1593–601. DOI: https://doi.org/10.1002/art.1780371106 Vasquez, A. Neuroinflammation in fibromyalgia and CRPS is multifactorial. Nat Rev Rheumatol. 2016;12:242. doi: 10.1038/nrrheum.2016.25 DOI: https://doi.org/10.1038/nrrheum.2016.25 Goebel A, Buhner S, Schedel R, Lochs H, Sprotte G. Altered intestinal permeability in patients with primary fibromyalgia and in patients with complex regional pain syndrome. Rheumatology. 2008;47:1223–7. doi: 10.1093/rheumatology/ken140 DOI: https://doi.org/10.1093/rheumatology/ken140 Pimentel M, Wallace D, Hallegua D, Chow E, Kong Y, Park S, et al. A link between irritable bowel syndrome and fibromyalgia may be related to findings on lactulose breath testing. Ann. Rheum. Dis. 2004;63(4):450-2. doi: 10.1136/ard.2003.011502 DOI: https://doi.org/10.1136/ard.2003.011502 Peuhkuri K, Vapaatalo H, Korpela R. Even low-grade inflammation impacts on small intestinal function. World journal of gastroenterology. 2010;16(9):1057-62. doi: 10.3748/wjg.v16.i9.1057 DOI: https://doi.org/10.3748/wjg.v16.i9.1057 Mourad FH, Barada KA, Bou Rached NA, Khoury CI, Saadé NE, Nassar CF. Inhibitory effect of experimental colitis on fluid absorption in rat jejunum: role of the enteric nervous system, VIP, and nitric oxide. Am J Physiol Gastrointest Liver Physiol. 2006;290:262-8. doi: 10.1152/ajpgi.00271.2005 DOI: https://doi.org/10.1152/ajpgi.00271.2005 Timms PM, Mannan N, Hitman GA, Noonan K, Mills PG, Syndercombe‐Court D, Boucher BJ. Circulating MMP9, vitamin D and variation in the TIMP‐1 response with VDR genotype: mechanisms for inflammatory damage in chronic disorders? Qjm. 2002;95(12):787-96. doi: 10.1093/qjmed/95.12.787 DOI: https://doi.org/10.1093/qjmed/95.12.787 RafteryT, Martineau AR, Greiller CL, Ghosh S, McNamara D, Bennett K, et al. Effects of vitamin D supplementation on intestinal permeability, cathelicidin and disease markers in Crohn’s disease: results from a randomised double-blind placebo-controlled study. United European gastroenterology journal. 2015;3(3):294-302. doi: 10.1177/2050640615572176 DOI: https://doi.org/10.1177/2050640615572176 Bashir M, Prietl B, Tauschmann M, Mautner SI, Kump PK, Treiber G, et al. Effects of high doses of vitamin D 3 on mucosa-associated gut microbiome vary between regions of the human gastrointestinal tract. European journal of nutrition. 2016;55(4):1479-89. doi: 10.1007/s00394-015-0966-2 DOI: https://doi.org/10.1007/s00394-015-0966-2 Smith EM, Samadian S. Use of the erythrocyte sedimentation rate in the elderly. Br J Hosp Med. 1994;51:394-7. doi: 10.3906/sag-1710-81 DOI: https://doi.org/10.3906/sag-1710-81 Block SR. Vitamin D deficiency is not associated with nonspecific musculoskeletal pain syndromes including fibromyalgia. In Mayo Clinic Proceedings. 2004;79(12):1585-6. doi: 10.4065/79.12.1585 DOI: https://doi.org/10.4065/79.12.1585 Atalay SG, Atalay R, Alkan BM, Fidan F, Bozkurt S, Aksekili H. Vitamin D deficiency in adults with musculoskeletal pain. Turk J Osteoporos. 2015;21(3):101-4. DOI: https://doi.org/10.4274/tod.19981 Ösken S, İçağasıoğlu A, Arslan P, Eğilmez Z, Murat S. 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DOI: https://doi.org/10.1016/j.neuropharm.2014.12.023 Copyright (c) 2023 Fulya Bakılan , Burcu Ortanca, Ayşe Ekim, Fezan Şahin Mutlu This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Introduction: The objective was to compare the rate and localization of trigger points and muscle strength in patients with and without pes planus. Methods: A total of 88 female patients were divided into two groups according to the presence (with the mean age of 32.50 ± 7.95) (n=52) or absence of pes planus (with the mean age of 33.5 ± 7.80) (n=36). Muscle strength was evaluated with handgrip-strength, leg-back strength. The presence of trigger points (present/absent), the pain region of trigger points (masseter muscle, cervical/thoracic/lumber regions, upper/lower extremity) and the Visual Analog-Scale for pain severity were detected. Results: The rate of trigger points was significantly higher in the pes planus group in all regions: in the masseter muscle (p=0.042), upper extremities (p=0.006), cervicotorasic region (p=0.020), lumbar region (p=0.014), and lower extremities (p=0.020). 98.1% of the patients with pes planus were found to have at least one trigger point. The pain severity of trigger points was significantly higher in pes planus group (p=0.037). However muscle strength were found to be significantly similar between the groups. Conclusion: A significant relationship was found between pes planus and the rate of having trigger points not only in lower extremities and lumbar region, but also in masseter, upper extremities and the servicotorasic region in females. However, any relationship were not found between pes planus and muscle strength.

Giriş: Bu çalışmanın amacı 1- tip 2 diyabet ile femoral kartilaj kalınlığı ve diz osteoartriti arasındaki ilişkiyi belirlemek, 2- bu ilişki üzerine beden kitle indeksi, abdominal bel çevresi, HbA1c gibi faktörlerin etkisini araştırmaktır. Yöntem: Bu çalışmaya toplam 126 kadın hasta kabul edilerek, hastalar diyabet varlığı (Diyabet grubu) ve yokluğuna (Kontrol grubu) göre iki gruba ayrıldı. Yaş, HbA1c, beden kitle indeksi, abdominal bel çevresi, vizüel analog skala, yürüme hızı, Kısa Form-36, Kellgren Lawrance Skalası ve ultrasonografik distal femoral kartilaj kalınlık ölçümü çalışmanın değişkenleri idi. Bulgular: İki grup arasında femoral kartilaj kalınlığı arasında bir fark saptanmadı, ne HbA1c ne de vücut kitle indeksi ve bel çevresi değerleri her 2 grupta da femoral kartilaj kalınlığı ile korelasyon göstermedi. Kontrol grubunda hem beden kitle indeksi(r=0.422) hem de bel çevresi(r=0.423) Kellgren skorları ile korelasyon gösterdi. Diyabet grubunda ise hem HbA1c(r=0.404), hem de beden kitle indeksi(r=0.696) ile Kellgren skorları arasında korelasyon saptanmakla birlikte, abdominal bel çevresi (r=0.791) ile Kellgren skorları arasındaki korelasyon daha güçlü düzeyde idi. Sonuç: Tip 2 diyabet ve diz osteoartriti arasında güçlü bir ilişki saptanmıştır ancak tip 2 diyabet ile ultrasonografik femoral kartilaj kalınlığı ölçümü arasında bir ilişki saptanmamıştır. Ayrıca tip 2 diyabet ve osteartritin arasındaki ilişkiye, abdominal obezite, HbA1c ve beden kitle indeksinden daha fazla katkı yapıyor görünmektedir.

Bu kitap, kas kısalık testlerinin uygulanması konusunda bilgi sunmayı amaçlamaktadır. Kitapta, en sık muayene edilen kasların anatomisi ve bu kaslara ait kısalık testlerinin nasıl uygulanacağı görsellerle anlatılmaktadır. Doğru kısalık tespiti, kas spesifik germe egzersizlerinin uygulanmasını sağlamaktadır. Kitabın yazılmasında osteopatik terapist Thaer Abokhorma, Prof. Dr. Merih Özgen, Dr. Mazlum Doğan Bilici ve Dr. Zeynep Nur Işlak'ın katkıları bulunmaktadır. Bu kitabın tıp fakültesi ve uzmanlık öğrencileri ile kas muayenesi yapan hekimlere yardımcı olması hedeflenmektedir. This book aims to provide information on the application of muscle length tests. The book explains the anatomy of the most commonly examined muscles and how to perform length tests for these muscles with visual illustrations. Accurate determination of muscle length enables the implementation of muscle-specific stretching exercises. The book was written with contributions from osteopathic therapist Thaer Abokhorma, Prof. Dr. Merih Özgen, Dr. Mazlum Doğan Bilici, and Dr. Zeynep Nur Işlak. The goal of this book is to assist medical faculty and specialization students, as well as physicians conducting muscle examinations.