Amaç: Bu çalýþmanýn amacý, vitamin D’nin sýçanlarda aðrý eþiði üzerine olan etkisini araþtýrmaktýr. Ayrýca, bir vitamin D reseptör agonisti olan EB1089’unda, reseptörün etkilerini artýrarak bu mekanizmaya katký saðlayýp saðlamayacaðýný incelemektir.
Gereç ve Yöntem: Çalýþmada 24 adet, üç aylýk ortalama 240-260 gram Wistar Albino erkek sýçan kullanýldý. Hayvanlar rastgele her grupta sekiz hayvan olmak üzere üç gruba ayrýldý. Gruplar; kontrol, vitamin D (10 µg/kg) ve EB1089 (10 µg/kg) olarak belirlendi. Antinosiseptif etkinin deðerlendirilmesinde tail flick ve hot plate testleri kullanýldý. Ölçümler ilaç uygulamalarýndan önce sýfýrýncý dakika ve ilaç sonrasýný takiben 30, 60 ve 90. dakikalarda alýndý ve süreler saniye cinsinden kaydedildi. Deney sonunda alýnan intrakardiyak kan örneklerinden elde edilen plazmada, ELISA yöntemiyle serotonin düzeyleri de incelendi.
Bulgular: Vitamin D ve EB1089, tail flick testinde kontrol grubuna göre anlamlý düzeyde aðrýya dayanma süresini artýrdý (p<0,05). Hot plate testinde ise EB1089 grubu, kontrol grubuna göre anlamlý düzeyde aðrý eþiði süresini uzatýrken (p<0,05), vitamin D grubu, kontrol grubundan yüksek latense sahip olmasýna raðmen anlamlý fark oluþturmadý (p>0,05). Serotonin düzeyleri açýsýndan ise gruplar arasýnda anlamlý bir fark bulunamadý (p>0,05).
Sonuç: Çalýþmanýn sonucunda vitamin D ve EB1089 uygulamasý hayvanlarda aðrý eþiðini artýrarak aðrýya karþý dayanýklýlýðý artýrdý.

Objectives: The aim of this study is to investigate the effect of vitamin D on pain threshold in rats. In addition, to examine, whether EB1089, which is a vitamin D receptor agonist, can contribute to this mechanism by increasing the effects of the receptor.
Methods: In the study, 24 male Wistar Albino rats of 3 months, an average of 240–260 g, were used. The animals were randomly divided into three groups, eight animals in each group. Groups; control, vitamin D (10 µg/kg), and EB1089 (10 µg/kg). Tail flick and hot plate tests were used to evaluate the antinociceptive effect. Measurements were taken at 0 min before drug administration and at 30, 60, and 90 min after drug administration and times were recorded in seconds. Serotonin levels were also analyzed by ELISA method in plasma obtained from intracardiac blood samples taken at the end of the experiment.
Results: Vitamin D and EB1089 significantly increased the time to endure pain in the tail flick test compared to the control group (p<0.05). In the hot plate test, EB1089 group significantly extended the pain threshold compared to the control group (p<0.05), while the vitamin D group did not create a significant difference, although it had a higher latency than the control group (p>0.05). There was no significant difference between the groups in terms of serotonin levels (p>0.05).
Conclusion: As a result of our study, the administration of vitamin D and EB1089 increased the pain threshold in animals and increased pain resistance.

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Amaç: Bu çalýþma, nöropatik aðrýlý servikal radikülopati hastalarýnda duyusal fenotipleri klinik muayene ve kantitatif duyusal testleri (QST) kullanarak tanýmlamayý ve saðlýklý gönüllülerle karþýlaþtýrmayý amaçlamaktadýr. Çalýþmanýn bir diðer amacý, Pain-Detect anketinin (PDQ) semptomatik bileþenlerinin, QST bulgularý ile iliþkilerini göstererek klinik pratikte duyusal anomalileri olan hastalarýn özellikli bir test olmaksýzýn tespitini saðlamada yardýmcý olmaktýr.
Gereç ve Yöntem: Nöropatik aðrýlý hastalar (n=20) ve saðlýklý gönüllüler (n=37) olmak üzere 57 katýlýmcý çalýþmaya dahil edildi. Katýlýmcýlarýn sosyodemografik ve klinik verileri alýndýktan sonra hastalara PDQ ve ardýndan tüm katýlýmcýlarda QST analizi yapýldý.
Bulgular: Aðrýlý ve aðrýsýz ekstremiteler arasýndaki analizlerde QST için tüm gruplarda fark bulunmadý (p>0,05). Duyusal eþikler saðlýklý gönüllülere göre nöropatik aðrýlý grupta daha yüksek, aðrý eþiði testleri daha düþük bulundu (p<0,05). Tarif edilen deðiþiklikler hem aðrýlý hem de aðrýsýz ekstremitelerde saptandý. PDQ komponenti olan hafif basýnçla aðrý, daha düþük ýsý aðrý eþik deðerleri ile korele bulundu (R=-0,602, p=0,005).
Sonuç: Nöropatik aðrýlý hastalarýn saðlýklý gönüllülere göre daha düþük aðrý eþiklerine ve daha yüksek duyusal eþiklere sahip olduðu görüldü. Ayrýca, PDQ’da aðrý ile basýnç bileþeni ve QST’de hiperaljezi arasýnda bir korelasyon gösterildi.

Objectives: This study aims to define and compare sensory phenotypes in cervical radiculopathy patients exhibiting neuropathic pain (NP) components with healthy volunteers using clinical examination and quantitative sensory test (QST) findings. Another aim of the study is to show whether symptomatic components of the pain detect questionnaire (PDQ) are correlated with the QST findings, which may help clinicians indicate patients with sensory abnormalities without the use of specialized tests.
Methods: Fifty-seven participants were included in the study, including patients with NP (n=20) and healthy volunteers (n=37). After obtaining the sociodemographic and clinical data of the participants, the PDQ was performed in patients with pain followed by QST analysis in all participants.
Results: Analyses between painful and non-painful extremities yielded no differences in all groups for QST (p>0.05). Sensory thresholds were found to be higher in the NP group compared to healthy volunteers, and the pain threshold test was found to be lower (p<0.05) in the intergroup analyses. The changes described were found in both painful and non-painful limbs. Pain with slight pressure was found to be correlated with the lower heat pain threshold values (R=−0.602, p=0.005).
Conclusion: Patients with NP were found to have lower thresholds for pain and higher sensory thresholds when compared to healthy volunteers. Moreover, pain with pressure component in PDQ was found to be associated with hyperalgesia in QST.

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Amaç: Bu çalýþmanýn amacý, hemþirelik öðrencilerinin aðrý deðerlendirmesine yönelik tutumlarýný ölçmek için kullanýlabilecek bir ölçek geliþtirmek, geliþtirilen ölçeðin geçerlilik ve güvenilirliðini deðerlendirmektir.
Gereç ve Yöntem: 2018 eðitim öðretim yýlýnda öðrenim gören 300 öðrenci ile metodolojik olarak yapýldý. Literatür taramasý ve öðrenci görüþleri ile 51 maddelik bir ölçek oluþturuldu. Ölçek beþ uzmanýn görüþüne sunuldu, içerik ve kapsam deðerlendirmesi yapýldý ve 45 maddelik son haline getirildi. Ölçek yapýsýnýn belirlenmesi için açýklayýcý ve doðrulayýcý faktör analizleri yapýldý. Ölçeðin güvenilirliðine iliþkin olarak, Cronbach Alfa (Crα) iç tutarlýk katsayýlarý ve 190 öðrenci üzerinde ise test tekrar test güvenilirliði hesaplandý.
Bulgular: Yapýlan döndürülmüþ temel bileþenler analizi sonucunda ölçek 15 maddeden oluþan iki faktörlü bir yapýya ulaþtý. Birinci faktör 12, ikinci faktör üç maddeden oluþmaktadýr. Bu iki faktör tutum deðiþkenine ait toplam varyansýn %65,953’ünü açýklamaktadýr. Ölçeðin madde test korelasyonlarý hesaplandý ve 0,463 ile 0,924 arasýnda deðerler bulundu. Yapýlan iç tutarlýlýk güvenilirlik testi sonucunda ölçeðin Crα deðeri 0,918; test tekrar test Crα deðeri de 0,738 bulundu.
Sonuç: Faktör analizi sonucu ölçeðin, tatmin edici düzeyde yapý geçerliðine ve iki faktörlü yapýya sahip olduðunu belirtmekte-dir. Madde test korelasyonu bulgularý ise ölçek maddelerinin geçerliðini ve ayný yapýyý ölçtüðünü göstermektedir. Ayrýca bütün Crα deðerlerinin 0,70’ten yüksek olmasý ölçeðin tatmin edici düzeyde güvenilirliðe sahip olduðunu açýklamaktadýr. Ölçeðin geçerlilik ve güvenilirliðine ait bulgular, üniversitede öðrenim gören hemþirelik öðrencilerinin ilgili özelliðe iliþkin tutumlarýný belirlemek üzere kullanýlabilir nitelikte olduðunu göstermektedir.

Objectives: This study aims to the development of nursing students’ attitudes scale toward pain assessment and establish its validity and reliability.
Methods: This was a methodological study conducted in the 2017–2018 academic year. The sample consisted of 300 nursing students attending at the Department of Nursing of Gazi and Selçuk Universities. First, a 51-item draft was developed based on a literature review and interviews with 25 students. Five experts were consulted for content validity. The items were revised, and six items were removed based on their feedback. The 45-item final version was applied to participants. Afterward, exploratory and confirmatory factor analyses were performed to determine the scale structure. Test-retest reliability was determined on 190 participants selected randomly from the sample.
Results: A 51-item draft was developed based on a literature review and interviews. Five experts were consulted for content validity, and six items were removed based on their feedback. The rotated principal component analysis revealed 15 items loaded on two factors. The total scale had internal consistency reliability (Cronbach’s alpha; α) of 0.918 and test-retest reliability of 0.738.
Conclusion: Factor analyses showed that the scale had satisfactory construct validity and a two-factor structure. All α values were higher than 0.70, indicating that the scale had a satisfactory level of reliability. All in all, it is a valid and reliable scale that can be used to measure nursing students’ attitudes toward pain assessment.

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Amaç: Bu çalýþmanýn amacý, çocuklarda kas iskelet sisteminde aðrý sýklýðýný ve iliþkili faktörleri deðerlendirmektir.
Gereç ve Yöntem: Gazimaðusa il merkezi ve çevre köylerde gerçekleþtirilen bu kesitsel çalýþmada 313 ilkokul öðrencisi analiz edildi. Öðrencilerin fiziksel aktiviteleri, kas iskelet sistemi aðrý düzeyleri, saðlýkla ilgili yaþam kaliteleri, beden kitle indeksleri, boylarý ve okul çantasý aðýrlýklarý kör bir araþtýrmacý tarafýndan ölçüldü.
Bulgular: Çalýþma grubunu yaþ ortalamasý 9,53±0,82 yýl olan 164 (%52,4) erkek ve 149 (%47,6) kýz öðrenci oluþturdu. Bu çalýþmada, kas iskelet sistemi aðrýsý sýklýðý %39,0 olarak bulundu. Kas iskelet sistemi aðrýsý ile yaþ, cinsiyet, beden kitle indeksi, haftalýk beden dersi saati, spora düzenli katýlým, haftalýk spor yapma süresi, okul çantasý tipi ve okul çantasý aðýrlýðý parametreleri arasýnda bir iliþki yoktu. Bu parametreler ile aðrý bölgesi arasýnda da bir iliþki yoktu.
Sonuç: Aþýrý yürüme ve oturma kas iskelet sistemi aðrýsý ile iliþkiliydi. Sanýlanýn aksine okul çantasý aðýrlýðý ve okul çantasý tipinin kas iskelet sistemi aðrýsý üzerinde etkili olmadýðý bulundu.

Objectives: The aim of this study was to evaluate the frequency of pain and related factors in musculoskeletal system in children.
Methods: A total of 313 primary school students were analyzed in this cross-sectional study conducted in the Famagusta city center and surrounding villages. The physical activity musculoskeletal pain (MSP) level, health-related quality of life weight, height, and school bag weights of the students were measured by a blinded researcher.
Results: The study group consisted of 164 (52.40%) boys and 149 (47.6%) girls with a mean age of 9.53±0.82 years. In the present study, MSP frequency was found to be 39.0%. There was no relationship between MSP and the following parameters: Age, sex, body mass index, hours of weekly gym lesson, regular participation in sports, weekly time spent with sports, school bag type, and school bag weight. There was also no relationship between these parameters and region of pain.
Conclusion: Excessive walking and sitting were associated with increased MSP. Contrary to popular opinion, it was found that school bag weight and school bag type were not effective on MSP. Our results show that the quality of life of children can be improved by reducing MSP.

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Amaç: Bu çalýþmanýn amacý, trigeminal nevraljide yüksek konsantrasyonda lokal anestezik ve steroid ile uygulanan periferik bloklarýn etkinlik süresinin araþtýrýlmasýdýr.
Gereç ve Yöntem: Kýrk sekiz hastanýn (dokuz hastaya medikal tedavi, 39 hastaya giriþimsel iþlem: periferik blok ve gasser ganglion radyofrekans termokoagülasyon [RFT]) verileri retrospektif olarak incelendi. Hastalarýn kullandýðý ilaçlar, giriþimsel iþlem uygu-lanan hastalarýn iþlem öncesi ve sonrasý visuel analog skala (VAS) skorlarý, iþlemin etkililik süresi 36 aylýk takiplerle deðerlendirildi.
Bulgular: Primer ve sekonder etyolojilerle tedavi edilen 48 hasta (32’si kadýn, 16’sý erkek) deðerlendirildi. Üç hasta V1, 12 hasta V2, 25 hasta V3, sekiz hasta V2+V3 trigeminal sinir dallarýna uygun klinik semptomlarý tanýmladý. Otuz bir hastaya sadece periferik blok, sekiz hastaya ise periferik blok sonrasý gasser ganglion RFT uygulandý. Periferik blok uygulanan aðrý þiddetinde ≥%50 azalma gözlenen hastalarda periferik bloklarýn ortalama etkinlik süresi 7,5 aydý. Gasser ganglion RFT uygulanan sekiz hastanýn hepsinde aðrý þiddeti ≥%50 azalma gösterdi, gasser ganglion RFT’nin ortalama etkinlik süresi 22,7 aydý (p=0,002). RFT sonrasý bir hastada damakta hipoestezi varken ciddi bir yan etki kaydedilmedi.
Sonuç: Trigeminal nevraljide periferik dal bloklarý için aðrý kontrolü süresi RFT kadar uzun deðildir. Ancak periferik blok uygulamasý kullanýlan yüksek konsantrasyonlu lokal anesteziðin nörotoksisitesinden dolayý iyi etkinlik süresi ile nispeten daha az invaziv ve daha kolay uygulanan bir giriþimsel tekniktir.

Objectives: The aim of this study was to investigate the effectiveness duration of the peripheral blocks applied with high concentration local anesthetic and steroid in trigeminal neuralgia.
Methods: The data of 48 patients (nine patients received medical treatment and 39 patients underwent interventional procedure for peripheral block and Gasser ganglion radiofrequency thermocoagulation [RFT]) were analyzed retrospectively. The medications used by patients, pre-operative and post-operative visual analog scale scores who underwent interventional procedures, and duration for effectiveness of the procedure were evaluated with 36 months follow-up.
Results: Forty-eight patients (32 females and 16 males) who were treated with primary and secondary etiologies were evaluated. Three patients V1, 12 patients V2, 25 patients V3, and eight patients V2+V3 trigeminal nerve branches described appropriate clinical symptoms. Only peripheral block was applied to 31 patients and Gasser ganglion RFT was applied to eight patients after peripheral block. In 24 patients who underwent peripheral block, pain severity reduction was ≥50%, mean effectiveness duration of peripheral block was 7.5 months. The eight patients undergoing Gasser ganglion RFT had ≥50% pain intensity reduction, mean effectiveness duration of Gasser ganglion RFT was 22.7 months (p=0.002). While one patient had hypoesthesia in the palate after RFT, no serious side effects were recorded.
Conclusion: The duration of pain control for peripheral branch blocks in trigeminal neuralgia is not as long as RFT, but it is a relatively less invasive and less complicated interventional technique with good efficacy duration due to neurotoxicity of the used high concentrated local anesthetic.

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Amaç: Omuz aðrýsý, kas iskelet sistemi aðrý sendromlarý arasýnda en sýk görülenlerden biridir. Konservatif tedavilere yanýt vermeyen hastalarda giriþimsel tedaviler uygulanabilir. Eklem içi steroid enjeksiyonu ve supraskapuler sinir blokunun her ikisi de kýsa etkilidir ve bazý durumlarda klinik olarak yetersiz kalabilmektedir. Bu çalýþmada, supraskapuler sinire pulse radyofrekans uygulamasýnýn bu giriþimlere ek fayda saðlayýp saðlamadýðý sorusunun cevabý araþtýrýlmýþtýr.
Gereç ve Yöntem: Ekim 2016 ile Nisan 2018 tarihleri arasýnda omuz aðrýsý olan ve enjeksiyon yapýlan hastalar geriye dönük olarak deðerlendirildi. Toplamda omuz enjeksiyonu uygulanan 160 hasta çalýþmaya dahil edildi. Hastalar iki gruba ayrýldý. Grup 1’e omuz içi steroid enjeksiyonu ve supraskapuler sinir bloku uygulanan 114 hasta; Grup 2’ye ise omuz eklem içi steroid enjeksiyonu ve supraskapuler sinir blokuna ek olarak supraskapuler sinire pulse radyofrekans uygulanan 46 hasta alýndý.
Bulgular: Giriþim öncesi NRS skorlarýnda gruplar arasýnda istatistiksel fark yoktu. Müdahaleden bir ay sonra grup 2’nin NRS skorlarý grup 1’den anlamlý derecede düþük bulundu. Her iki grupta da giriþimden bir ay sonraki NRS skorlarý giriþim öncesine göre anlamlý derecede düþüktü. Grup 2’de enjeksiyonun etki süresi grup 1’den daha uzundu. Grup 2’deki hastalarýn memnuniyet yüzdeleri grup 1’den istatistiksel olarak daha yüksek bulundu.
Sonuç: Glenohumeral eklem içi steroid enjeksiyonu ve supraskapuler sinir blokuna ek olarak supraskapuler sinire pulse radyofrekans uygulamasý NRS skorlarý, etki süresi ve hasta memnuniyeti açýsýndan ek fayda saðlamaktadýr.

Objectives: Shoulder pain is one of the most common musculoskeletal pain syndromes. Interventional treatments can be applied to patients who do not respond to conservative therapies. Intra-articular steroid injection and suprascapular nerve block are both short-acting and may sometimes be clinically inadequate. In this study, the answer to the question of whether pulse radiofrequency application to the suprascapular nerve provides additional benefit was investigated.
Methods: Patients who had shoulder pain and were injected between October 2016 and April 2018 were evaluated retrospectively. Totally 160 patients who underwent shoulder injections were included in the study. Patients were divided into two groups: 114 patients who underwent shoulder intra-articular steroid injection and suprascapular nerve block, as Group 1 and 46 patients who underwent pulse radiofrequency to the suprascapular nerve, in addition to shoulder intra-articular steroid injection and suprascapular nerve block, as Group 2.
Results: There was no statistical difference between the groups in pre-intervention numerical rating scale (NRS) scores. One month after the intervention, NRS scores of Group 2 were significantly lower than Group 1. In both groups, 1 month after the intervention NRS scores were significantly lower than pre-intervention. The duration of pain relief for Group 2 was longer than Group 1. The satisfaction percentages of patients for Group 2 were higher than Group 1.
Conclusion: In addition to glenohumeral intra-articular steroid injection and suprascapular nerve block, pulse radiofrequency application to the suprascapular nerve provides additional benefits in terms of NRS scores, duration of pain relief, and patient satisfaction.

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Amaç: Bu çalýþmanýn amacý, çocuklar ve ebeveynler için aðrý felaketleþtirme ölçeðini Türkçeye (AFÖ-Ç, AFÖ-E) çevirmek ve primer baþ aðrýsý olan çocuklarda psikometrik özellikleri deðerlendirmektir.
Gereç ve Yöntem: Yapý geçerliliðini test etmek için açýklayýcý faktör analizi kullanýldý. Güvenilirlik: madde-toplam puan korelasyonu, iç tutarlýlýk (Cronbach α katsayýsý), madde silinmiþse Cronbach α ve test-tekrar test korelasyonu kullanýlarak ölçüldü. Ölçeklerin eþ zamanlý geçerliliði ve yakýnsak geçerliliði, diðer ölçekler [revize edilmiþ çocuklarýn anksiyete ve depresyon ölçeði (RÇADÖ), RÇADÖ-E, çocuklar için yaþam kalitesi ölçeði (ÇÝKYO), ÇÝKYO-E] ve ilgili bazý özellikler (aðrý yoðunluðu, cep telefonu kullaným süresi, baþ aðrýsý süresi) ile iliþkilendirildi.
Bulgular: Çalýþmaya katýlan 80 çocuðun 55’i (%68,8) kýz, 25’i (%31,2) erkekti. AFÖ-Ç, AFÖ-E için orijinal üç faktörlü yapýnýn desteklenmediði belirlendi. On iki maddeden oluþan AFÖ-Ç için Cronbach α deðeri 0,871, 12 maddeden oluþan AFÖ-E için Cronbach α deðeri 0,890 olarak bulundu. ÇÝKYO puaný arttýkça AFÖ-Ç’nin her üç alanýnda da negatif korelasyon (p<0,05, r=–0,575) ve RÇADÖ ölçeði ile AFÖ-Ç puanlarý arasýnda pozitif korelasyon (p<0,05) vardý. Benzer þekilde, ÇÝKYO-E ve AFÖ-E ile negatif korelasyon ve RÇADÖ-E ve AFÖ-E ile pozitif korelasyon vardý (her biri için p<0,05).
Sonuç: AFÖ-Ç, AFÖ-E yeterli geçerlilik ve güvenilirliðe sahip bir deðerlendirme aracýdýr ve primer baþ aðrýsý olan çocuk hasta çalýþmalarýnda geçerli ve güvenilir bir þekilde kullanýlabilir.

Objectives: The aims of this study were to translate the pain catastrophizing scale for children and parents (PCS-C and PCS-P) into Turkish (TurPCS-C and TurPCS-P) and evaluate the psychometric properties in children with primary headache.
Methods: Exploratory factor analysis was used to test the construct validity. Reliability was measured using item-total score correlation, internal consistency (Cronbach α coefficient), Cronbach α if the item was deleted, and test-retest correlation. Concurrent validity and convergent validity of the scales were correlated with other scales (Revised Children’s Anxiety and Depression Scale [RCADS], RCADS Parent RCADS-P, Quality of Life Scale for Children [PedsQL], and PedsQL-Parents [PedsQL-P]) and some related features (pain intensity, mobile phone usage time, and headache duration).
Results: Of the 80 children participating in the study, 55 (68.8%) were girls and 25 (31.2%) were boys. It was determined that the original three-factor structure was not supported for TurPCS-C and TurPCS-P. Cronbach α value was 0.871 for TurPCS-C consisting of 12 items, and Cronbach α value was 0.890 for TurPCS-P consisting of 12 items. As the PedsQL score increased, there was a negative correlation (p<0.05, r=−0.575) in all three areas of TurPCS-C, and there was a positive correlation (p<0.05) among the scores from the RCADS scale and TurPCS-C. Similarly, there was a negative correlation with PedsQL-P and TurPCS-P and positive correlation with RCADS-P and TurPCS-P (p<0.05 for each).
Conclusion: TurPCS-C and TurPCS-P are an evaluation instrument with sufficient validity and reliability, and it can be reliably used to examine pediatric patients with primary headache.

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Amaç: Bu çalýþmanýn amacý, Hashimoto tiroiditi tanýsý alan hastalarda primer baþ aðrýsý insidansýný ve potansiyel biyobelirteçleri deðerlendirmektir.
Gereç ve Yöntem: Endokrinoloji polikliniðine baþvuran Hashimoto tiroiditi olan hastalar çalýþmaya dahil edildi. Demografik veriler, tiroid fonksiyon test sonuçlarý ve otoantikor titreleri kaydedildi. Baþ aðrýsýnýn klinik özellikleri de belirlendi. Ayný araþtýr-macý, tüm hastalarda baþ aðrýsý þiddeti derecelendirmesi için görsel analog ölçeði (VAS) kullandý.
Bulgular: Primer baþ aðrýsý olan 95 (%61,3) hastadan 20’si (%21,1) migren, 17’si (%17,9) gerilim tipi baþ aðrýsý (TTH) ve 20’si (%21,1) yeni günlük kalýcý baþ aðrýsý (NDPH) tanýsý aldý. Yüz elli beþ kiþiden 38’inde (%24,5) hipotiroidizme baðlý baþ aðrýsý (HRH) tespit edildi. Baþ aðrýsý tipi ile yüksek kan antikor düzeyi (anti-TPO) arasýnda istatistiksel olarak anlamlý iliþki bulunmazken (p=0,135), tiroid uyarýcý hormon (TSH) ile pozitif korelasyon saptandý (p<0,001). Migrenli Hashimoto hastalarýnda (n=14, %70,0) daha yüksek kan antikor düzeyleri bulunurken, bu oranlar HRH’de %86,8 (n=33), TTH hastalarýnda %76,5 (n=13), NDPH hastalarýnda %60,0 (n=12) olarak saptandý. Elli yedi hasta Hashimoto tanýsý aldýktan sonra yeni bir baþ aðrýsý tanýmlarken, hormon tedavisi sonrasý baþ aðrýsý devam eden hasta sayýsý 48 idi. Bu da primer baþ aðrýsý ve Hashimoto hastalýðý komorbiditeyi göstermekteydi.
Sonuç: Baþ aðrýsý ile iliþkili tek faktörün TSH düzeyi olmasý patofizyolojide farklý mekanizmalarýn rol oynadýðýný düþündürdü. Primer baþ aðrýsý tanýsýnda tedavi edilebilen sekonder nedenlerin detaylý araþtýrýlmasý önem taþýmaktadýr.

Objectives: The purpose of this study was to evaluate the incidence of primary headache and potential biomarkers in patients diagnosed with Hashimoto thyroiditis.
Methods: Patients with Hashimoto thyroiditis referred to the outpatient endocrinology clinic were included in the study. The demographic data, thyroid function test results, and autoantibody titers were recorded. The headache’s clinical characteristics were also determined. The same researcher used the visual analog scale for headache severity rating in all patients.
Results: 155 patients with Hashimoto thyroiditis were included the study. There were 95 (61.3%) cases diagnosed with headache consisting of 20 (21.1%) migraine cases, 17 (17.9%) tension type headaches (TTHs), and 20 (21.1%) new daily persistent headaches (NDPHs). 38 of 155 (24.5%) had hypothyroidism related headaches (HRHs). There was no statistically significant relationship between the headache type and a high blood antibody level anti thyroid peroxidase antibody (p=0.135), while a positive correlation was found with thyroid stimulating hormone (TSH) (p<0.001). Hashimoto patients with migraine (n=14, 70.0%) were found to have higher blood antibody levels, while these ratios were found as 86.8% (n=33) in HRH-patients, 76.5% (n=13) in TTH-patients, and 60.0% (n=12) in NDPH-patients. 86 of 155 (55.5%) patients reported new onset headaches after a Hashimoto’s thyroiditis diagnosis, and the headaches persisted without hormone therapy in 48 (84.2%) of these patients. These patients diagnosed with primary headache and this was interpreted as demonstrating comorbidity between Hashimoto’s disease and primary headaches.
Conclusion: Detection of only the relationship between TSH level and headache suggested that different mechanisms play a role in the pathophysiology. In the diagnosis of primary headache, it is important to look into secondary reasons.

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Amaç: Çalýþmanýn amacý, engelli çocuklara ve yaþlý bireylere formal bakým veren personelin bel aðrýsý, depresyon ve tükenmiþlik düzeylerini incelemek ve karþýlaþtýrmaktýr.
Gereç ve Yöntem: Tanýmlayýcý, kesitsel bir desende olan bu çalýþmaya engelli çocuklara bakým veren 29 personel (grup 1) ve yaþlý bireylere bakým veren 26 personel (grup 2) dahil edildi. Katýlýmcýlarýn sosyodemografik özellikleri sorgulandý. Bireylerin bel aðrýsýnýn deðerlendirilmesinde standardize Nordik muskuloskeletal anketinin bel aðrýsý ile ilgili kýsmý kullanýldý. Bireylerin depresyon düzeylerini deðerlendirmede Beck depresyon ölçeði, tükenmiþlik düzeylerini ölçmek için Maslak tükenmiþlik envanteri kullanýldý. Veri analizinde ortalama, standart sapma, frekans, yüzde deðerleri ile karþýlaþtýrmalý istatistiklerden t testi ve kategorik deðiþkenlerde ki-kare ve Fisher-Exact test kullanýldý.
Bulgular: Bel aðrýsý parametresinde sadece aðrý sýklýðý durumu için iki grup arasýnda fark olduðu görüldü (p=0,039). Gruplar karþýlaþtýrýldýðýnda depresyon düzeylerinde anlamlý fark olduðu (p=0,001), tükenmiþlik düzeyleri karþýlaþtýrýldýðýnda ise fark olmadýðý görüldü (duygusal tükenme p=0,21; duyarsýzlaþma p=0,952; kiþisel baþarý p=0,066).
Sonuç: Bu çalýþmaya dahil edilen engelli çocuklara ve yaþlý bireylere bakým veren personelin benzer þekilde orta düzeyde tükenmiþlik yaþadýðý, bunun yanýnda aðrý sýklýðý haricinde bel aðrýsý bakýmýndan benzer yakýnmalara sahip olduðu görüldü. Engelli çocuklara bakým veren personelin depresyon düzeyinin yaþlý bireylere bakým veren personele göre daha yüksek olduðu bulundu. Sonuç olarak, bakým iþinin her iki grupta da hem fiziksel hem de psikososyal sorunlara yol açabileceði görüldü.

Objectives: The aim of the study was to investigate and compare the low-back pain, depression, and burnout levels among formal caregivers of elderly individuals and children with disability.
Methods: This descriptive and cross-sectional study included 29 caregivers of children with disabilities (Group 1) and 26 caregivers of elderly individuals (Group 2). The sociodemographic characteristics of the participants were questioned. The part of low back pain in the Standardized Nordic Musculoskeletal Questionnaire was used to estimate of low back pain. Beck Depression Inventory and Maslach Burnout Inventory were used to evaluate the levels of depression and burnout, respectively. In analysis, percentage values, mean, standard deviation, frequency, and t-test for comparative statistics and Chi-square and Fisher Exact test for categorical variables were used.
Results: There was a significant difference between the two groups only for the frequency of pain (p=0.039). There was a significant difference in depression levels between the groups (p=0.001) and no difference in the burnout level of the among groups (emotional exhaustion p=0.21; depersonalization p=0.95; and personal achievement p=0.066).
Conclusion: It was observed that the disabled and elderly care personnel included in this study similarly experienced moderate burnout, and they also had similar complaints in terms of low back pain, except for the frequency of pain. It was found that the depression levels of the disabled child caregivers were higher than the elderly caregivers. As a result, it has been seen that care work can cause both physical and psychosocial problems in both groups.

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Brakiyal pleksus bloklarýndan sonra lokal anestetikler klavikula altýna yayýlmaz ve sefalik bir eðilimle epidural boþluða yayýlabilir. Periferik bloklara kontrast madde ekleyerek lokal anestezik yayýlmanýn klavikula bütünlüðüne göre nasýl olacaðýnýn gösterilmesi amaçlandý. Boyun-omuz bileþkesinde klavikulanýn oluþturduðu bariyerin >2 cm kýrýkta kaybolduðu ve ilaç daðýlýmýnýn kaudal geçiþ gösterdiði gözlemlendi. Klavikula kýrýðýnýn tipi ve derecesinin ilaç difüzyonunu deðiþtirdiði ve blokun baþarýsýný etkilediði düþünüldü.

After the brachial plexus blocks, local anesthetics do not diffuse under the clavicle and can spread to the epidural space with a cephalic tendency. We aimed to show how the local anesthetic spread will be according to the integrity of the clavicle by adding contrast agent to the peripheral blocks. We observed that the barrier created by the clavicle at the neck-shoulder junction disappeared in fracture >2 cm and the drug distribution showed a caudal transition. We think that the type and degree of clavicle fracture changes the drug diffusion and affects the success of the block.

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Süperior kluneal sinir (SKS), alt torasik ve lomber sinir köklerinin dorsal ramusundan köken alan bir duyusal sinirdir. Bel aðrýsýnýn gözden kaçan nedenlerinden biri SKS tuzaklanma nöropatisidir. SKS tuzaklanma nöropatisi, bel hareketleri ve paravertebral kas tonus artýþý sebebiyle oluþan kötü vücut postürüne baðlý SKS gerilmesi ile de iliþkilendirilebilir. Elli dokuz yaþýnda kadýn hasta sað iliyak kreste lokalize olan ve sað kalça, kasýk ve bacaða yayýlan kronik bel aðrýsýyla baþvurdu. Hastanýn lomber lordozu artmýþtý ve anterior pelvik tilti mevcuttu. Sað iliyak krest üzerinde hassas nokta vardý ve aðrý kalça ve posterolateral uyluða yayýlýyordu (tinel bulgusu +). Hastaya alt çapraz sendrom ve SKS tuzaklanma nöropatisi tanýsý konuldu ve terapötik sinir bloku yapýldý. Klinisyenler bel aðrýsý tanýsýnda SKS tuzaklanma nöropatisini göz önünde bulundurmalýdýrlar.

The superior cluneal nerve (SCN) is a sensory nerve known to be originated from the dorsal rami of the lower thoracic and lumbar nerve roots. One of the overlooked causes of low back pain (LBP) is the SCN Entrapment Neuropathy (SCNEN). SCNEN may also be associated with SCN stretching due to lumbar movement and the poor body posture through an increase in the paravertebral muscle tonus. A 59-year-old female patient presented with chronic LBP localized on the right iliac crest and radiating to the right buttock, groin, and leg. She had increased lumbar lordosis and anterior pelvic tilt. She had a tender point over the right iliac crest, and the pain was radiating to the buttock and posterolateral thigh (Tinel sign +). She was diagnosed with lower crossed syndrome and SCNEN, and a therapeutic nerve block was performed. Clinicians should consider SCNEN as a possible diagnosis of LBP.

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Ýskemik aðrý, ekstremitelere yetersiz kan akýmýyla sonuçlanan bir grup hastalýðýn ana semptomudur. Bu semptomatolojide iki ana hastalýk ayýrt edilir: Kritik vasküler hastalýk ve Raynaud fenomeni. Kritik vasküler hastalýk diabetes mellitus veya hipertansiyonun neden olduðu aterosklerozun zemininde geliþmektedir. Raynaud fenomeni primer ve sekonder forma ayrýlýr. Primer form vazospazmdan nedenlidir ve altta yatan bir neden yoktur. Ýkincil form, altta yatan bað dokusu veya romatizmal hastalýklar, tromboanjitis obliterans (Burger hastalýðý) gibi periferal vasküler hastalýklarla iliþkilidir. Raynaud hastalýðýnda klinik bulgular, soðuða maruz kalma ile morarma, soðukluk, aðrýlý parestezi gibi vazomotor deðiþiklikler ve kronik iskemiden kaynaklanan ülserlerdir. Kritik iskemik hastalýkta klinik prezentasyon, erken evre için intermittan kladikasyo ve ileri evrelerde istirahat aðrýsý, kangren, nekroz ve trofik deðiþiklikler de eklenir. Raynaud hastalýðýnýn erken evrede tedavisi medikal ve konservatiftir. Ýleri evre iskemik vasküler hastalýk, týbbi tedaviye dirençli aðrý, endovasküler tedaviye yetersiz yanýt, inoperabl olgular gibi durumlarda sempatektomi ve spinal kord stimülasyonu gibi giriþimler uygulanabilir. Spinal kord stimülasyonu vazodilatör mediyatörler ile vasküler direnci azaltýr ve kan akýmýný artýrýr. Spinal kord stimülasyonu ayrýca sempatik vazokonstrüksiyonu baskýlar, doku kanlanmasýný artýrýr, doku hasarýný azaltýr, ülser iyileþmesini saðlar ve aðrýyý azaltýr. Bu olgu sunumunda dirençli Raynaud hastalýðýnýn ve ileri evre Burger hastalýðýnýn spinal kord stimülasyonu ile baþarýlý bir þekilde tedavi edildiði gösterildi.

Ischemic pain is the main symptom of a group of diseases that result in inadequate blood flow to the extremities and ischemia. In this symptomatology, two major diseases are distinguished: Critical vascular disease and Raynaud’s phenomenon. Critical vascular disease background of atherosclerosis caused by diabetes mellitus or hypertension. Raynaud phenomenon is divided into primary and secondary form. The primary form is due to vasospasm and there is no underlying cause. Secondary form is associated with underlying connective tissue or rheumatic diseases, peripheral vascular diseases such as thromboangitis obliterans (Burger’s disease). Clinical findings in Raynaud’s disease are vasomotor changes with cold exposure such as bruising, coldness, painful paresthesias, and ulcers due to chronic ischemia. Clinic presentation in critical ischemic disease is intermittent claudication for earlier stage and resting pain, gangrene, necrosis, and trophic changes were added in advanced stages. The treatment of the Raynaud ‘s disease in early stage is medical and conservative. In case of advanced stage ischemic vascular disease, medical treatment resistant pain, insufficient response to endovascular treatment, and inoperabl cases, interventions such as sympathectomy and spinal cord stimulation (SCS) can be applicable. SCS reduces vascular resistance through vasodilator mediators and increases blood flow. SCS also suppresses sympathetic vasoconstriction, increases tissue vascularity, reduces tissue damage, provides ulcer healing and pain reduction. In this report, we demonstrated that persistent Raynaud’s disease and advanced stage Burger’s disease were successfully treated with SCS.

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