Ankylosing spondylitis (AS) is a chronic inflammatory disorder of the axial skeleton. In recent years, several authors reported an increased prevalence of sexual dysfunction among AS patients. We aimed to find out, whether the prevalence of erectile dysfunction among AS patients is different from age-matched healthy controls. Thirty-seven male patients with AS who were diagnosed according to the modified New York criteria and 67 normal healthy controls (NHC) were included in this study. Clinical characteristics of patients including age, disease duration and morning stiffness were noted. Disease activity was evaluated by using Bath AS disease activity index (BASDAI), functional statement was evaluated by using Bath AS functional index, and scores of spinal measurements were done by using Bath AS metrology index. Erectile function is evaluated using the International Index of Erectile Function (IIEF) scoring system. Health-related quality of life was assessed by short form 36. The mean age of the patients and controls were 42.8 + 10.8 and 43.6 + 5.9 years (P = 0.666). The prevalence of erectile dysfunction in AS patients and NHC were 35.1 and 26.9%, respectively (P = 0.335). There was no statistically significant difference between IIEF domain scores of AS patients and NHC except for the sexual desire domain (P = 0.014). Duration of morning stiffness and BASDAI was negatively correlated with sexual desire and overall satisfaction; however, they have no negative impact on erectile function, orgasmic function and intercourse satisfaction domains of IIEF. In this report, we showed that only the sexual desire domain of IIEF was significantly lower in AS patients. The prevalence of erectile dysfunction among AS patients is similar to NHC, which is a finding contrary to previous reports. AS patients do not suffer from erectile dysfunction, they rather have problems of satisfaction from the intercourse.
a relatively common surgical approach for closed procedures in infants and children with congenital cardiac malformations. This approach results in division of the latissimus dorsi and serratus anterior muscles. Division of these muscles can result in significant postoperative pain, diminished pulmonary function, and marked impairment of motion.The thoracotomy incision may also result in longterm physical impairment and deformity. Scoliosis has been reported to develop with an incidence of 22% several years after left posterolateral thoracotomy for correction of aortic coarctation in infancy and childhood. 1 The long-term musculoskeletal consequences of thoracotomy for surgical treatment of congenital cardiac disease, however, have seldom been evaluated. [2][3][4][5][6] With this in mind, we sought to determine whether a posterolateral thoracotomy performed in children with congenital cardiac disease influences the postoperative anatomy and function of the musculoskeletal system. Materials and methodsWe evaluated 49 children, 28 boys and 21 girls, undergoing surgery through a posterolateral thoracotomy in the forth-intercostal space for treatment of congenital cardiac disease at Hacettepe University Hospital. An additional median sternotomy was needed in 9 (18%) of the patients.By means of a general clinical examination and radiological studies, we evaluated thoracic symmetry, Cardiol Young 2003; 13: 264-267 Abstract The standard surgical approach for closed heart procedures in small infants and children is to use a posterolateral thoracotomy incision, which results in the division of the latissimus dorsi and serratus anterior muscles. The aim of our study was to determine the frequency and type of musculoskeletal deformities in children undergoing surgery with this approach for congenital cardiac disease.We included 49 children, 28 boys and 21 girls, in the study. Their mean age was 10.2 Ϯ 4.8 years, the mean age at the time of surgery was 3.8 Ϯ 4.0 years, and they were evaluated at an average of 6 years after the thoracotomy. Of the patients, 94% had various musculoskeletal deformities. Scoliosis was observed in 15 patients (31%) but only in two patients did the curves exceed 25 degrees. Of these patients, three-fifths had aortic coarctation. Elevation of the shoulder was seen in 61%, winged scapula in 77%; while 14% had asymmetry of the thoracic wall due to the atrophy of the serratus anterior muscle. Deformity of the thoracic cage was observed in 18%; and 63% had asymmetry of the nipples.Thus, we found that musculoskeletal deformities are frequent after thoracotomies in children with congenital cardiac disease. Patients who have undergone such procedures for cardiac or noncardiac surgery should be followed until their skeletal maturation is complete. Techniques sparing the serratus anterior and latissimus dorsi muscles should be preferred. These adverse effects of thoracotomy may be another reason for using interventional procedures in these cases.
In this study, we evaluated the relationship between the severity of enthesitis and outcome of measurement indices, clinical and laboratory parameters in patients with ankylosing spondylitis (AS). Thirty-three patients who fulfilled the modified New York criteria for AS were included in this study. Patients were asked to record the severity of current pain, night pain and morning stiffness on a 10-cm visual analogue scale. Stoke Enthesitis Index (SEI) was used to measure the severity of enthesitis. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI) and Bath Ankylosing Spondylitis Metrology Index (BASMI) were calculated. SEI was correlated positively only with BASDAI (r = 0.370, P = 0.034). There was no relation between SEI and laboratory parameters (Erythrocyte Sedimentation Rate and C Reactive Protein). Our data suggest that using an enthesitis index such as SEI can be a valuable tool in the evaluation of disease activity in patients with AS. However, evaluation of enthesitis severity is based on information given by patient and should be combined with objective parameters such as spinal measurements when assessing disease activity.
In this study, we evaluated fatigue by using the multidimensional assessment of fatigue (MAF) index in 68 ankylosing spondylitis (AS) patients. To determine the disease activity, functional status and quality of life, bath ankylosing spondylitis disease activity index (BASDAI), bath ankylosing spondylitis functional index (BASFI) and Short Form 36 (SF36) were used respectively. Mander enthesis index (MEI) was used for evaluation of enthesitis. The mean age of the patients was 37.7 (11.1) years. The prevalence of fatigue was 76.5%. There were significant correlations between MAF and BASDAI (P < 0.001), BASFI (P < 0.001), MEI (P = 0.048), pain (P = 0.001), hemoglobin (P = 0.001), ESR (P = 0.035), dorsal Schober's (P = 0.009), occiput-wall distance (P = 0.048). Also MAF was correlated with all dimensions of SF36 except for social function and emotional role. BASFI was found to be the most significant correlated (P = 0.002) parameter with MAF. This study suggests that fatigue is an important symptom in AS and it seemed to occur in severe AS patients. It should appropriately be measured with respect to its intensity with appropriate measures, such as MAF. Moreover, fatigue may increase functional disability, which is already present as a feature of the disease.
Objective: Measurement of Serum Vitamin D levels in patients with knee osteoarthritis and compare with age matched healthy population in order to assess their association. Design: Prospective clinical control study. Methods: Clinically proven two hundred patients of osteoarthritis knee (OA) and two hundred control included in study according to inclusion and exclusion criteria on OPD basis after getting written and informed consent, Serum 25-OHD was measured by the ELISA method and concentrations <20 ng/ml were considered as deficient levels. Results: Four hundred subjects participated in study. The mean ages of patients and controls were 59.2 ± 12.9 and 58.9 ± 10.2 years respectively. The mean 25OHD in OA patients aged <60 years was significantly lower than controls (19.8 ± 18.8 vs. 36.7 ± 27.5 ng/ml, p< 0.01). In this age group knee OA was significantly associated with serum 25-OHD deficiency. The association between OA and serum 25-OHD deficiency in patients aged ≥60 years did not reach a significant level. Conclusions: These findings indicate a significant association between serum 25-OHD deficiency and knee OA in patients aged <60 years and suggest serum 25-OHD measurement in any patient with symptoms suggestive of knee OA particularly at the initial stage of disease. Introduction Osteoarthritis (OA) is the most common disease of joints in adults around the world [1]. Worldwide, it is estimated to be the fourth leading cause of disability [2]. Nearly one-third of all adults have radiological signs of osteoarthritis [3]. Clinically too, significant osteoarthritis of the knee, hand, or hip is reported to affect around 8.94% of the adult population [4]. Its prevalence increases gradually in individuals older than 40 years. Studies suggests that prevalence of OA knee is >60% in subjects older than 70 years [5, 6]. Community survey data in rural and urban areas of India shows the prevalence of osteoarthritis to be in the range of 17 to 60.6% [7, 8, 9]. The disease usually evolves with increasing levels of pain, mobility restriction and physical disability [5, 10]. About 80% of persons affected by OA already report having some movement limitation and 20% report not being able to perform major activities of daily living; with an 11% of the total affected population reporting the need of personal care [11]. Both vitamin D deficiency and OA knee are age dependent and worldwide problem [12]. Vitamin D status influences the incidence and progression of knee OA [13]. Sunlight exposure and serum 25-OHD levels are both associated with decreased knee cartilage loss [14]. Previous studies also suggest that in serum 25-OHD deficient men the prevalence of OA was two times greater than those with sufficient levels [15]. In OA, changes in subchondral bone play an essential role in the onset and progression of cartilage lesions. In this condition bone resorption markers are higher and bone formation markers are lower compared with a control group. In progressive OA, bone metabolism and bone turnover are increased similar to tha...
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