Knee osteoarthritis (OA) is one of the most common forms of joint disease, affecting an increasing number of people worldwide. Latest data suggests that inflammation plays a critical role in the pathogenesis of OA. There are a number of inflammatory markers like cytokins and cartilage degradation products that can be used as indicators in OA. Blood neutrophil-lymphocyte ratio (NLR) is a simple non-invasive and cost-effective marker of inflammation in various systemic diseases, but it has not been investigated in OA yet. The aim of the present study was to compare blood NLR levels in patients with severe - Kellgren and Lawrence (KL) grade 4 - knee OA and mild to moderate - KL grades 1-3 - knee OA. A total of 176 patients with knee OA were included in this cross-sectional study. KL grading was done according to the two-view (antero-posterior and lateral) plain radiography of both knees. Demographic characteristics, blood neutrophil, lymphocyte and platelet counts, erythrocyte sedimentation rate, and C-reactive protein were recorded. Blood NLR levels were calculated. In the severe knee OA group, blood NLR levels were found to be elevated as compared to the mild to moderate knee OA group. A blood NLR of ≥2.1 was taken as the cutoff based upon the receiver operating characteristics (roc). In the roc curve analysis, blood NLR ≥ 2.1 had 50 % sensitivity and 77 % specificity in predicting severe knee OA. In multivariate analysis, age and blood NLR ≥ 2.1 emerged as independent predictors of severe knee OA. The results of the present study, for the first time in the literature, suggests blood NLR as a novel and promising inflammatory marker indicating the severity of knee OA.

These findings show that the CET thickness was reduced after 10 sessions of acupuncture treatment in LE patients.

Objectives: This study aims to measure the carotid artery intima-media thickness (IMT) of patients with fibromyalgia (FM) by using ultrasound imaging and to investigate whether carotid IMT measurements were associated with the severity of FM. Patients and methods: Nineteen female patients (mean age 42.9±8.1 years; range 24 to 57 years) and 17 healthy female subjects (mean age 41.5±6.3 years; range 33 to 57 years) were included in this study. The Fibromyalgia Impact Questionnaire was used to determine the severity of FM. After clinical evaluation of the subjects, ultrasound imaging examinations of the carotid IMT were performed. Results: Right and left carotid IMT values were thicker in the patient group in comparison to the control group (p1=0.05, p2=0.03, respectively). Carotid IMT values were correlated with age and body mass index. Carotid IMT values did not have any correlation with blood glucose levels, creatinine levels, serum lipid profile and Fibromyalgia Impact Questionnaire scores in FM patients. Conclusion: Carotid IMT of FM patients seems to be affected. Our finding may have stemmed from endothelial dysfunction possibly due to increased sympathetic activity.

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SummaryObjectives: To compare the efficacy of two different dry needling (DN) techniques (deep dry needling & peppering) in myofascial pain syndrome (MPS). Methods: Seventy-two patients, who were diagnosed as MPS at our outpatient clinic were randomly assigned into two groups as deep dry needling (DDN) and peppering. All patients were evaluated four times as: before the treatment and 1-5-12 weeks after the completion of treatment protocol. In each evaluation, Visual analogue scale (VAS), Nottingham extended activities of daily living scale (NEADLS), Beck depression inventory (BDI) scores were recorded. Additionally, all patients were evaluated for the pain felt during the procedure and side effect profile. Results: Twenty-six patients from DDN group and twenty-eight patients from peppering group accomplished the follow-up period. Both DDN and peppering seem to be effective for relieving pain and depressive symptoms and improving functionality compared to baseline when evaluated on the 1 st , 5 th and 12 th weeks. On the other hand the intergroup analyses showed no significant differences between DDN and peppering groups. The only significant difference between the groups is the lesser pain felt during the procedure in the DDN group. Conclusion: Both DDN and peppering are effective in MPS and the effects last up to 12 weeks. Also the adverse event profiles of the two techniques are similar. On the other hand, DDN is a painless procedure.Keywords: Deep dry needling; dry needling; myofascial pain syndrome; peppering. ÖzetAmaç: Çalışmanın amacı iki farklı kuru iğneleme yönteminin (derin kuru iğneleme ve peppering) miyofasial ağrı sendromunda (MAS) karşılaştırılması. Gereç ve Yöntem: Hastanemize başvuran MAS tanısı alan 72 hasta, rasgele derin kuru iğneleme ve peppering olmak üzere iki gruba ayrıldı. Tüm hastalar 4 kez değerlendirildi; tedaviden önce ve tedavide uygulamasından sonraki 1.-5. ve 12. haftalarda. Her değerlendirmede hastalara Vizüel Analog Skala, Nottingham Genişletilmiş Günlük Yaşam Aktiviteleri Skalası ve Beck Depresyon Ölçeği uygulandı. Ek olarak hastalar prosedür boyunca ağrı hissi ve yan etki profili açısından takip edildi. Bulgular: Takip sürecini 26 derin kuru iğneleme ve 28 peppering hastası tamamladı. Başlangıca göre bakıldığında her iki grupta da 1.-5. ve 12. hafta kontrollerinde ağrının azaltılması, depresif semptomları ve fonksiyonelliğin artırlması açısından fayda sağlandı. Öte yandan gruplararası analizlerde her iki grup arasında anlamlı fark saptanmadı. Her iki grup arasındaki tek anlamlı farklılık uygulama sırasında derin kuru iğneleme grubunda ağrının daha az olmasıydı. Sonuç: Derin kuru iğneleme de peppering de MAS tedavisinde etkili ve bu etki 12 haftaya kadar devam etmektedir. Ayrıca her iki tekniğin de yan etki profili benzer saptandı. Öte taraftan, derin kuru iğnelemenin daha ağrısız bir prosedür olduğu görüldü.Anahtar sözcükler: Derin kuru iğneleme; kuru iğneleme; myofasial ağrı sendromu; peppering.

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Although biphosphonates showed robust efficacy in fracture prevention, recent data revealed a number of adverse events. Atypical femoral fracture is one of them. Here, a 73 year old female patient who continued alendronate therapy despite unilateral atypical femoral fracture and developed the second one on the other side one year later is presented. The purposes of this manuscript are; emphasizing atypical femoral fracture as an adverse event with increasing incidence, reviewing the knowledge about duration of biphosphonate therapy and drug holiday and highlighting that biphosphonates should be stopped in the presence of an atypical femoral fracture and this should be explained to the patient in a clear way especially if he/she is elderly.

Objectives: Knee osteoarthritis (OA) is a widespread disease that increases in the elderly and is an important cause of morbidity. It is common knowledge that resting and nocturnal pain is rarely seen in patients with knee OA, however latest studies showed that it is not rare. Sleep disorders are thought to be related with nocturnal pain and it is shown that in patients with arthritis are more likely to develop sleep problems. Nocturnal pain is also related with depression and decreased quality of life. This study aims to evaluate sleep quality in patients with knee OA and to reveal the relationship between severity of knee OA, pain and sleep disorders and quality of life in female and male patients. Materials and Methods: This cross sectional study includes 41 volunteer patients (27 female,14 male) between 40-65 years with knee OA, who suffer from knee pain for more than 6 months, and the study includes patients with grade 2 and 3 OA according to the Kellgren-Lawrence classification. Patients were evaluated using Visual Analog Scale (VAS),