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Öğe A new approach in the treatment of ultrasound-guided synovial hypertrophy(Tubitak Scientific & Technological Research Council Turkey, 2025) Guler, Emel; Doganci, AlperBackground/aim: Knee osteoarthritis (OA) causes pain and limited movement, negatively impacting daily life in older adults. Hypertrophy and changes in the synovial tissue significantly contribute to the pain. While intraarticular injections are common in OA treatment, specific therapies for hypertrophic tissue are rarely mentioned. This study aimed to evaluate the long-term outcomes of local anesthetic and steroid injections in the knee's intraarticular space and hypertrophic synovial tissue. Materials and methods: Our retrospective study included patients with grade 3 or 4 knee OA diagnosed with ultrasound-guided suprapatellar effusion and synovial hypertrophy. Pain was assessed using a numerical rating pain scale (NRS) and functional capacity was evaluated with the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index. Effusion was first drained from the suprapatellar region using a 22-gauge spinal needle under ultrasound guidance, followed by lavage with 40 mL of 0.9% NaCl solution. A mixture of 10 mL (2 mL triamcinolone hexacetonide, 7 mL of prilocaine, and 1 mL of 0.9% NaCl) was injected intraarticularly, and 6 mL was injected into the hypertrophic synovial tissue. Patients were followed before the injection and at 1, 3, 6, 9, and 12 months after the injection. Results: Analysis of the WOMAC scores and NRS values at 1, 3, 6, 9, and 12 months after the injection revealed statistically significant reductions (p < 0.05). No statistical difference was found between the duration of complaints and WOMAC scores or NRS values (p > 0.05). Ultrasound evaluation indicated regression of the synovial hypertrophy tissue. Conclusion: This injection method, practiced in the treatment of synovial hypertrophy as one of the causes of pain in knee OA, reduced pain and significantly increased functional capacity.Öğe A Randomized Comparison Between Interscalene and Combined Interscalene-Suprascapular Blocks for Arthroscopic Shoulder Surgery: A Prospective Clinical Study(Dove Medical Press Ltd, 2024) Pehlivan, Sibel Seckin; Gergin, Ozlem Oz; Aksu, Recep; Guney, Ahmet; Guler, Emel; Yildiz, KaramehmetBackground: To compare the analgesic effect of ISB with a combination of ISB-SSNB and patients who were given opioids with PCA without block in adult patients undergoing shoulder surgery, as measured by opioid consumption and pain intensity in the first 24 hours postoperatively. Methods: Ninety patients who underwent shoulder surgery were randomly divided into three groups. Group I in which ISB was performed and patient-controlled analgesia (PCA) was inserted, Group II with; ISB and SSNB combined, and PCA was inserted, and Group III where; only PCA was used. Visual analog scale (VAS) pain scores at the second, fourth, sixth, 12th, and 24th hours, morphine consumption, additional analgesic requirement, and patient satisfaction were evaluated. Results: Compared with Group III, the VAS pain score was significantly lower in Group I and Group II at 2, 4, 6, 12, and 24 hours postoperatively. In Group I, the VAS score at rest at the 6th hour was found to be higher than in Group II. The 24-hour total morphine consumption was higher in the control group than in Group I and Group II. The satisfaction score of the control group was lower than Group I and Group II. Conclusion: The combined application of ISB and SSNB block is beneficial in shoulder surgery to provide both intraoperative and postoperative analgesia and opioid consumption.Öğe Autoantibodies are not associated with familial mediterranean fever(MEDFARMA-EDICOES MEDICAS, LDA, 2012) Guler, Emel; Kaptanoglu, Ece; Sahin, Ozlem; Candan, Ferhan; Hayta, Emrullah; Elden, HasanObjective: It has been suggested that Mediterranean fever (MEFV) gene mutations are also seen in certain autoimmune diseases and are related to severity of the disease activity. As most of the clinical symptoms of these inflammatory diseases are related to autoantibody positivity, we assessed autoantibody prevalence in patients with Familial Mediterranean fever (FMF) and investigated the relationship between clinical involvement of FMF and the autoantibodies. There are a few studies on this subject with conflicting results. Patients and Methods: Fifty patients with FMF without attack and 27 healthy controls were enrolled to the study Clinical characteristics of the patient group were questioned. Rheumatoid factor (RE), anti-cyclic citrullinated peptide (anti-CCP) values, Fluorescent antinuclear antibody (ANA), extractable nuclear antigen (ENA) profile was studied in both groups. Results: No statistically significant difference was found in ANA, ENA profile, anti-CCP, and RF positivity between the groups (p>0.05). There was no relationship between the autoantibodies and the clinical status in patients with FME MEFV gene mutations were identified in 98% of the FMF patients. Conclusion: In conclusion, autoantibody positivity is similar to the healthy population in FME Although MEFV mutations affect clinical course in other autoantibody mediated diseases, it is not related to autoantibody formation in FMEÖğe Clinical reflection of anatomical evaluation in coccydynia(Soc Anatomica Espanola, 2024) Guler, Emel; Guler, Ilkay; Arslan, Ayla; Uzun, Gokce BagciCoccydynia is a pain in the coccyx and the surrounding anatomical structures. Our aim in the study was to evaluate whether the disease duration, pain assessment, and coccyx morphological type had an effect on this clinic in patients with a diagnosis of coccydynia. A total of 68 coccyx Magnetic Resonance Imaging (MRI) results were evaluated. Coccyx segment number, morphological typing, lumbosacral, sacrococcygeal, and intercoccygeal angle measurements were made. Disease duration, day and night movement and the rest of Numerical Pain Scale (NRS) values were recorded from existing records of patients with a diagnosis of coccydynia. When the morphological typing was evaluated, type 4 subluxation was found to be high in the group with coccydynia. Pain complaint duration was 13.94 +/- 12.22 months, sitting time was 16.82 +/- 14.22 minutes, and the numerical pain scale was 7.62 +/- 1.48. Morphologically, type 1;14 (3 coccydynia), type 2;22 (9 coccydynia), type 3;14 (6 coccydynia), type 4;18 (16 coccydynia) images were also detected. A moderately statistically significant positive cor-- relation was found between the sacrococcygeal and intercoccygeal angles (p<0.05). We believe that evaluating clinical data and anatomical measurements together will contribute to the treatment of coccydynia, which is especially difficult to treat.Öğe Effect of carnosine on ovarian follicle in rats exposed to electromagnetic field(Soc Anatomica Espanola, 2022) Arslan, Ayla; Balcioglu, Esra; Nisari, Mehtap; Yalcin, Betul; Ulger, Menekse; Guler, Emel; Uzun, Gokce BagciThe electromagnetic field (EMF) has an effect on various organs, including the female reproductive system. The purpose of this study was to evaluate the impact of carnosine on ovarian follicle number and diameter in rats exposed to a 900 Megahertz (Mhz) electromagnetic field. In this study, six different groups were used. 40 female rats divided into groups were evaluated. The ovaries of the rats were removed at the end of the study. Routine histological procedures were performed on ovarian tissues. Follicle number and diameter of all groups were calculated and evaluated under the light microscope. When primary follicle number and diameters were compared statistically among the groups, there was a remarkably meaningful difference between the EMF group and the control, 20 mg carnosine and EMF+20 mg carnosine groups (p<0.05). There were significant irregularities in the structure of the oocyte and the granulosa cells surrounding the oocyte, especially in the EMF-treated groups. However, the structure of the oocyte and the granulosa cells surrounding the oocyte in the EMF+20 mg carnosine group showed a more regular structure compared to the EMF group. In this study, it can be concluded that the number and diameter of ovarian follicles decreased in rats exposed to electromagnetic field and 20 mg of carnosine may prevent damage caused by EMF.Öğe Effect of Disease Duration and Activity and the Treatment Process on Central Sensitization in Patients with Ankylosing Spondylitis(2022) Guler, Emel; Doğancı, Alper; Gültürk, Esra; Artık, Hanzade Aybüke Ünal; Hizmetli, SamiObjective: Ankylosing spondylitis (AS) is a chronic inflammatory disease. Its main symptom is inflammatory low back pain. The presence of central sensitization (CS) in chronic pain conditions has been emphasized in several studies, but there are insufficient studies on AS patients. The aim of this study was to evaluate the relationship between disease activity in AS, the type of pain, and the presence of CS. Methods: Patients’ age, gender, body mass index, disease duration, drugs used in the treat ment, pain type and severity, presence of CS disease activity, and quality of life were evaluated. Results: Evaluation was made on 80 patients, comprising 49 (61.2%) females and 31 (38.8%) males. A statistical significance was found between the presence of CS and high scores of painDETECT, Bath Ankylosing Spondylitis Disease Activity Index, Numerical Rating Scale for pain, Ankylosing Spondylitis Disease Activity Index-sedimentation, Ankylosing Spondylitis Quality of Life Index, low Short-Form-12 (SF-12) physical score (***p<0.001), low SF-12 men tal score (**p<0.01), and increased age (* p<0.05). Conclusion: The results of this study demonstrated that as CS was present in the majority of AS patients, multidirectional evaluation of these patients is required, and in treatment approaches, evaluation is important in respect of treatments for CS in addition to the sup pression of inflammation.Öğe Effects of age, gender and modifiable risk factors on low back pain(2023) Guler, Emel; Özer, Firuzan FıratLow back pain increases with age and causes a burden of serious socio-economic adverse outcomes. Gender, age, vitamin D insufficiency, and obesity are some of the factors that are considered accountable for the etiology of low back pain, however, conflicting results are present in the literature regarding their effects on low back pain. In this study, we aimed to evaluate the effect of pain duration, pain intensity, gender, and preventable risk factors including vitamin D and body mass index (BMI), on low back pain. File registration data of 274 patients (211 females, 63 males) were included in this retrospective study. Age, gender, pain intensity, BMI, and vitamin D levels were recorded. Patients aged 60 and over were considered as the geriatric group. We observed that higher Visual Analogue Scale (VAS) scores were significantly associated with increased BMI (p=0.007) and advanced age (p=0.049). Duration of pain was positively correlated with, age (p<0.001) and BMI (p=0.02). There was no significant relation between VAS scores and vitamin D levels. The duration of the disease was longer in women than men (p=0.038), but no significant difference was observed for VAS scores between genders. When the study group was divided into geriatric and non-geriatric groups, disease duration was higher in the geriatric group (p<0.001), but no significant difference was observed between VAS scores. BMI, which is among the modifiable risk factors, is closely related to low back pain. The increase in both BMI and VAS scores, especially with advancing age, indicates that overweight older individuals are at high risk for low back pain.Öğe Pain type and neuropathic pain components in acute herpes zoster(Kare Publ, 2024) Unal, Hanzade Aybuke; Ogut, Neslihan Demirel; Guler, Emel; Alptekin, AlpObjectives: The aim of this study was to investigate the pain type (nociceptive or neuropathic) and neuropathic pain components in patients with acute herpes zoster (HZ). Methods: Patients with acute HZ referred to the outpatient Dermatology and Venereology clinic between January 2021 and January 2022 were retrospectively detected. The demographic data including gender and age, rash localization, pain severity, and neuropathic pain components were recorded. Pain severity and neuropathic pain components were evaluated using a Visual Analog Scale (VAS) and Douleur Neuropathique 4 (DN4), respectively. Results: The study included a total of 58 patients, comprising 33 females and 25 males. Of these patients, 35 (60.3%) were found to have neuropathic pain. Itching, burning, pins and needles, and tingling were the most frequently reported neuropathic pain signs and symptoms. The proportion of female patients with neuropathic pain was found to be significantly higher than that of male patients (p=0.021). No significant differences were observed in the distribution of pain across different body sites or in the age of patients with neuropathic pain (p>0.05). Itching was significantly more common in younger patients (p=0.02). Conclusion: In conclusion, the study found that over half of the patients with acute HZ experienced neuropathic pain, and this was more frequently observed in female patients. Analysis of different components of neuropathic pain showed significant differences in age, gender, and site distribution. The findings of this study may have important implications for the management and treatment of acute HZ.Öğe Psychopathology, Family Functioning and Marital Relationship in Female Patients with Fibromyalgia Syndrome(UNIVERSITATSVERLAG ULM GMBH, 2010) Kugu, Nesim; Kaptanoglu, Ece; Kavakci, Onder; Guler, EmelObjective: Fibromyalgia syndrome (FMS) is a chronic widespread painful syndrome of middle-aged women. Psychological problems, especially depression and anxiety are common among the FMS patients. High alexithymia scores have been reported before. It is suggested that FMS has a negative effect on family and marital relationships. In this study, we aimed to search whether there is a difference between the FMS and osteoarthritis patients with chronic pain regarding the psychopathologic features, alexithymia and the effects of these diseases on family and marital relationships. Patients and Methods: Fifty-four female FMS patients and 33 osteoarthritis patients as controls were included in the study. All patients were given a socio-demographic Data Form, Visual Analogue Scale (VAS) for pain, Toronto Alexithymia Scale (TAS), Symptom Check List-90 Revised (SCL-90-R), Marital Life Scale (MLS), Marital Conflict Questionnaire (MCQ), and Family Assessment Device (FAD). Fibromyalgia Impact Questionnaire (FIQ) was given only to the FMS patients. Results: TAS Scale 1 (difficulty in describing the feelings) and TAS total mean scores of FMS patients were significantly higher compared to the control group (p<0.05). The mean scores of SCL-90-R and Global Symptom Index (GSI) subscales, except the paranoid ideation were also significantly higher in FMS group compared to control group (p<0.05). MLS scores were comparable in the FMS and control groups (p>0.05). Regarding MCQ, both Conflict Expansion Score (CES) and Frequency of Conflict Score (FCS) mean values were significantly higher in FMS patients (p<0.05). The mean scores of roles and affective responsiveness subscales of FAD were higher in the FMS group compared to the controls (p<0.05). There were positive correlations between the FIQ scores and obsessive-compulsive (r=0.35, p=0.01), interpersonal sensitivity (r=0.28, p=0.04), depression (r=0.36, p=0.00), anxiety (r=0.41, p=0.00), phobic anxiety (r=036, p=0.00), hostility (r=0.30, p=0.03) and psychoticism (r=0.39, p=0.00) subscales of SCL-90-R. Conclusion: According to the results of our study, there is a "difficulty in describing the feelings" which is an alexithymic component, more general psychopathology regarding SCL-90-R, more conflict in marital relations, and more problems in family functioning especially in areas of affective responsiveness and roles within the family in FMS patients compared to the controls with chronic pain. These findings indicate that multi-dimensional interventions are necessary in the treatment of FMS and instead of concentrating only on chronic pain handling of the family and marital relations negatively affected by accompanying psychopathologic features and disorders of the FMS patients should also be cared.Öğe Pulse Steroid Therapy Induced Multifocal Osteonecrosis(AVES, 2014) Dogan, Sevil Ceyhan; Elden, Hasan; Hayta, Emrullah; Guler, Emel; Salk, Ismail…Öğe Relation of bone mineral density with fat infiltration of paraspinal muscles: The Goutallier classification(Elsevier, 2024) Ozer, Firuzan Firat; Guler, EmelObjectives: Muscle and bone tissue are interrelated throughout their developmental processes via paracrine and endocrine pathways. Osteosarcopenia has emerged with the growing data proving the high rate of simultaneous occurrence of sarcopenia and osteoporosis. We aimed to evaluate the relationship between osteoporosis, and muscle quality by grading the fatty infiltration in paraspinal muscles according to the Goutallier classification in magnetic resonance imaging (MRI). Methods: Data of postmenopausal patients who underwent MRI for low back pain were analyzed retrospectively. Lumbar spine and femoral neck bone mineral density (BMD) were measured by using dual energy X-ray absorptiometry (DXA). Grade of paraspinal muscle fatty infiltration for each level of lumbar vertebrae including L1L2, L2-L3, L3-L4, was evaluated separately according to Goutallier classification system. Results: A total of 91 postmenopausal women were included in the study. The mean age of the study population was 60.5 +/- 11. Lumbar vertebrae L1-L4 total T-scores and BMD g/cm2 were lower in patients with higher grades of Goutallier classification (P = 0.031 and P = 0.023, respectively). The distribution of the severity of fatty degeneration was significantly higher in the osteoporosis/osteopenia group at all 3 disc levels. No significant correlation was observed between femoral neck BMD and paraspinal muscle fat infiltration. Conclusions: There is a strong relationship between osteoporosis of the lumbar spine and paraspinal muscle quality, which can be considered as a reflection of osteosarcopenia. The Goutailler classification can be an effective and easy method in the evaluation of muscle quality with MRI.Öğe The relationship between disability and depression, anxiety, and sleep quality in patients with coccydynia(Kare Publ, 2024) Guler, Emel; Unal, Hanzade AybukeObjectives: In this study, our aim was to investigate the relationship between sleep quality, anxiety, depression, and disability in patients with coccydynia. Methods: This prospective cross-sectional study evaluated 60 patients diagnosed with coccydynia. Clinical and demographic characteristics of the patients were recorded. Outcome measures included the Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Pittsburgh Sleep Quality Index (PSQI), which were analyzed. Results: Depressive symptoms and anxiety were detected in 47 (78.3%) and 49 (81.6%) of the 60 patients, respectively. Additionally, 46 (76.7%) patients were identified as poor sleepers. Our results demonstrated a statistically significant positive correlation between the quality of sleep and anxiety and depressive symptoms scores (p<0.001); there was also a statistically weak positive correlation with disability index values. Conclusion: Depressive symptoms, anxiety, and poor sleep quality are exacerbated by disability in coccydynia. While coccydynia has been previously associated with neurotic disorders, the mechanisms underlying poor sleep quality remain unclear.Öğe The relationship of psychological factors and sleep quality with the severity of carpal tunnel syndrome(Asean Neurological Assoc, 2022) Guler, Emel; Soykok, GuelayCarpal tunnel syndrome (CTS), the most common entrapment neuropathy, is graded as mild, moderate and severe. We aimed to evaluate the relationship between CTS severity and depression, anxiety, sleep quality and daytime sleepiness. One hundred and forty-nine patients with a diagnosis of CTS were prospectively included in the study. There was a statistically significant difference between the painDETECT questionnaire, age, pain severity, Pittsburgh Sleep Quality Scale, Boston CTS Symptom Severity Scale and Functional Status Scale scores and the severity of CTS (p<0.05). There was a statistically significant difference between the Epworth sleepiness scale and the severity of CTS (p<0.05). There was no statistically significant difference between body mass index, Beck Anxiety, Beck Depression Score and CTS severity (p>0.05). We found an increase in daytime sleepiness in the severe type of CTS, which particularly affects hand functions and causes a decrease in the quality of life.
