Is magnesium citrate treatment effective on pain, clinical parameters and functional status in patients with fibromyalgia?

The aims of this study were to investigate the relationship between magnesium levels and fibromyalgia symptoms and to determine the effect of magnesium citrate treatment on these symptoms. Sixty premenopausal women diagnosed with fibromyalgia according to the ACR criteria and 20 healthy women whose age and weight matched the premenopausal women were evaluated. Pain intensity, pain threshold, the number of tender points, the tender point index, the fibromyalgia impact questionnaire (FIQ), the Beck depression and Beck anxiety scores and patient symptoms were evaluated in all the women. Serum and erythrocyte magnesium levels were also measured. The patients were divided into three groups. The magnesium citrate (300 mg/day) was given to the first group (n = 20), amitriptyline (10 mg/day) was given to the second group (n = 20), and magnesium citrate (300 mg/day) + amitriptyline (10 mg/day) treatment was given to the third group (n = 20). All parameters were reevaluated after the 8 weeks of treatment. The serum and erythrocyte magnesium levels were significantly lower in patients with fibromyalgia than in the controls. Also there was a negative correlation between the magnesium levels and fibromyalgia symptoms. The number of tender points, tender point index, FIQ and Beck depression scores decreased significantly with the magnesium citrate treatment. The combined amitriptyline + magnesium citrate treatment proved effective on all parameters except numbness. Low magnesium levels in the erythrocyte might be an etiologic factor on fibromyalgia symptoms. The magnesium citrate treatment was only effective tender points and the intensity of fibromyalgia. However, it was effective on all parameters when used in combination with amitriptyline.

Effects of strontium ranelate on cortical bone collagen integrity.

OBJECTIVE: To investigate the effect of strontium ranelate on bone collagen cross-linking in an ovariectomized rat model. METHODS: Twenty-eight adult (12 weeks) albino female Wistar rats weighing between 200-250 g (n=7 per group) were divided into sham-operated, ovariectomized, prevention, and treatment groups. Animals in the prevention group were treated with strontium ranelate (500 mg/kg/day orally) for 120 days, starting immediately after ovariectomy. Animals in the treatment group were treated with strontium ranelate (500 mg/kg/day orally) for 120 days, starting 90 days after ovariectomy. At the end of the experimental period, stress, strain, and toughness of the cortical femur was measured, and collagen ultrastructure was evaluated. The study was conducted in Mersin University Biophysics Laboratory, Mersin University, Mersin, Turkey from January to May 2008. RESULTS: Stress, strain, and toughness values decreased in ovariectomized, prevention, and treatment groups when compared with the sham-operated group. In this study, fiber organization was observed in the sham-operated group, whereas the parallel packing of fibrils was completely replaced by a random arrangement in the ovariectomized, prevention, and treatment groups. CONCLUSION: Strontium ranelate treatment did not repair collagen cross-linking in ovariectomized rats.

Validation of a Turkish version of the burn-specific health scale.

The abbreviated Burn-Specific Health Scale (BSHS) is an instrument that measures physical, mental, social, and general health in burn survivors. This scale is composed of 80 items. The aim of this study was to determine the reliability and validity of a Turkish version of the BSHS (the BSHS-Turkish). The BSHS-abbreviated was translated and adapted for Turkish persons according to standard procedures. After a telephone interview with all eligible patients, the BSHS-Turkish was mailed to 103 burn patients. Fifty-three patients (51.46%) filled out both questionnaires; the second one was completed within 15 days of the first one. The mean time that it took to complete the questionnaire was 31.06 +/- 15.2 minutes (range, 3-60 minutes). The test-retest, internal reliability, and construct validity of the BSHS-Turkish were satisfactory according to intraclass correlation coefficient, Cronbach's alpha, and the Mann Whitney U test. The BSHS-Turkish is a reliable and valid instrument for determining the health status of Turkish patients with burns.

[Determining the biomechanical quality of normal and osteoporotic bones in rat femora through biomechanical test and finite element analysis]. / Normal ve osteoporotik siçan femurunda kemigin biyomekanik kalitesinin biyomekanik testle ve sonlu elemanlar analizi ile belirlenmesi.

OBJECTIVES: This study aimed to determine the biomechanical quality of cortical bone in normal and osteoporotic rat femora with the use of biomechanical analysis and finite element analysis. METHODS: Fourteen young adult female Sprague-Dawley rats weighing 225-250 g were randomized into two groups equal in number. One group underwent bilateral ovariectomy under ketamine anesthesia. Fourteen weeks after ovariectomy, bone mineral density was measured by dual energy X-ray absorptiometry in two groups and the rats were sacrificed under high-dose ketamine anesthesia for removal of all the femora. The right femora were subjected to biomechanical tension tests. In the left femora, cortical bone sections were visualized by computed tomography and finite element analysis was performed on computer-generated three dimensional images using the ANYSIS 9.0 software. Deformation, stress, and strain values obtained by the two analyses were compared. RESULTS: Compared to the control group, bone mineral density decreased by 29%, and decreases in deformation, stress, and strain values were 39%, 51%, and 64%, respectively, in the ovariectomized rats (p<0.05). No significant differences were found between the results of biomechanical measurements and finite element analysis (p>0.05). CONCLUSION: Our data suggest that finite element analysis can be used in vivo to determine biomechanical quality of bone in osteoporotic patients.

Low-exposure cadmium is more toxic on osteoporotic rat femoral bone: mechanical, biochemical, and histopathological evaluation.

This study aimed to investigate the effects of low-exposure Cd on normal and osteoporotic bone. For this purpose, 12-week-old Sprague-Dawley female rats were assigned randomly to a control group, a Cd group, and an ovariectomy (OVX)+Cd group. OVX+Cd rats underwent bilateral ovariectomy via ventral incision. Twelve weeks after ovariectomy, cadmium chloride (CdCl(2)) was given to rats (Cd and OVX+Cd groups) as intraperitoneal (ip) injection of 0.5mg/kg three times a week for 18 weeks and distilled water was given to control group via ip route for 18 weeks. Bone mineral density (BMD) was measured at mid-diaphysis femoral region by dual-energy X-ray absorbsiometry. Cross-sectional area of the femoral shaft was evaluated by computerized tomography. Biomechanical measurements were performed at the mid-diaphysis of the left femur. Collagen fibers were evaluated at light microscopic level. BMD, cortical thickness, cortical area, and femur length were not changed in Cd and OVX+Cd groups in comparision to controls. In the OVX+Cd group, strength, displacement, energy, stress, strain, and toughness were significantly lower than those of the control group. The Cd concentration of bone was significantly increased in the OVX+Cd group compared to that in the control group. Collagen fiber intensity was decreased in all groups except control group. The results of the present study indicate that the administration of low-dose Cd does not affect normal bone biomechanical parameters, but it has a significant effect on osteoporotic bone.

Biomechanical evaluation in osteoporosis: ovariectomized rat model.

The aim of our study was to investigate the effects of ovariectomy on rat femur biomechanical parameters. Bone mineral density (BMD) and histological investigation were also evaluated. Fourteen female Sprague-Dawley rats (seven ovariectomized, seven control) were used. BMD was measured by dual-energy X-ray absorbsiometry. Bone biomechanical parameters were measured in femoral midshaft with tensile test using a biomaterial testing machine and maximum load, stiffness, energy absorption capacity (structural properties), ultimate stress, ultimate strain, and elastic modulus (material properties) were calculated. Diaphyseal cortical bone thickness was measured by using histological method. The ovariectomized (OVX) rat femur's BMD was 14% lower than control rats (p=0.006). Mean maximum load was 55% less than the control group's (p=0.0001). Stiffness was 72% less in OVX rats (p=0.05). Femurs of rats with OVX had 32% less absorbed energy than controls (p=0.09). From the stress-strain curve ultimate stress, ultimate strain and elastic modulus was calculated. Elastic modulus was 53% less than controls (p=0.05). Ultimate stress decreased 21% in OVX rats (p=0.097). Ultimate strain was 25% less than controls in OVX rats. Cortical thickness was significantly decreased in OVX rats than in controls (p<0.05). In conclusion, femur biomechanical parameters are decreased in osteoporosis.

Coexistence of fibromyalgia, temporomandibular disorder, and masticatory myofascial pain syndromes.

The purpose of this study was to determine the association of fibromyalgia (FM) with temporomandibular disorder (TMD) and masticatory myofascial pain (MMP). Thirty-one consecutive women diagnosed as having FM according to American College of Rheumatology criteria and 21 consecutive women diagnosed as having TMD were included in this prospective study. All patients were examined by a dentist and a physiatrist to identify the coexistence of FM and TMD. In the FM group, TMD was found in 25 (80%) patients, and only 6 (19%) patients had arthrogenous origin with MMP, whereas 19 (81%) patients had only MMP without arthrogeonous orgin of those 25 women exhibited TMD. In the TMD group, the prevalence of FM was 52%, which was significantly higher in those with TMD of arthrogenous origin with MMP. Our results indicate that coexistence of FM and TMD with MMP is high. Pain and tenderness in the masticatory muscles appear to be an important element in FM, so in some patients it may be the leading complaint.

Quality of life after burn injury: the impact of joint contracture.

We sought to investigate quality of life, and to specifically assess how joint contracture affects it, in patients with burn injuries. The study is involved 22 adults with burn injuries. Patients were divided into two groups according to the presence (n = 11) or absence (n = 11) of any joint contracture. Patient age, sex, date of burn injury, burn type, location, and extent of burn (TBSA) were recorded for each case. Each individual underwent a thorough musculoskeletal system examination, with special focus on range of motion of the joints. Quality of life was evaluated using the Short Form 36 (SF-36). Eight (36.4%) of the patients were women, and 14 (63.6%) were men, and their mean age (+/- SE) was 24.7 +/- 4.68 years. The mean interval from injury to the study assessment was 21.45 +/- 14.69 months. Eleven patients (50%) had at least one joint contracture. The patients with one or more contractures had significantly lower scores for the SF-36 subscales of physical functioning, physical role limitations, bodily pain, and vitality (P = .05, P = .01, P = .04, and P = .02, respectively). In the 22 patients overall, TBSA was negatively correlated with the scores for the SF-36 subscales vitality and emotional role limitations (r = -.586 and r = -.805, respectively). Joint contracture does impact burn patients' quality of life, especially with respect to physical functioning, physical role limitations, bodily pain, and vitality. In addition, the amount of BSA burned is correlated with psychosocial problems and poorer quality of life, regardless of whether joint contractures develop.

Acute effect of single-dose cadmium treatment on lipid peroxidation and antioxidant enzymes in ovariectomized rats.

We investigated the acute effect of single-dose cadmium (Cd) treatment on lipid peroxidation and antioxidant enzymes in liver and kidney of rats following an ovariectomy operation. Twenty-eight female Wistar albino rats were used and were divided into four groups: I, control (n=7); II, cadmium (Cd, n=7); III, ovariectomized (Ovx, n=7); and IV, ovariectomized+cadmium (Ovx-Cd, n=7). Fourteen of the rats were ovariectomized. Twelve weeks later, cadmium chloride (CdCl(2), 5 mg/kg) was administered i.p. as a single dose to the Cd and Ovx-Cd groups. Twenty-four hours after the injection, all rats were sacrificed and had their liver and kidney tissues removed for the measurement of superoxide dismutase (SOD), catalase (CAT), and malondialdehyde (MDA) levels. SOD activity showed a significant decrease (P<0.001) in both organs of Ovx and Cd rats in comparison to controls. CAT activity was significantly decreased (P<0.01) in the liver of Ovx and Cd groups but not in the kidneys of both groups compared to control values. MDA concentrations were higher (P<0.05) in both organs of Ovx and Cd rats than those values observed in the control group. Similar patterns of changes were observed in the Ovx-Cd rats, but the increase in the MDA levels and the decrease in the antioxidant enzymes for the Ovx-Cd group were higher than those of the Ovx and Cd groups. Based on the data, it can be stated that cadmium increases the effect of ovariectomy on lipid peroxidation, impairs the antioxidant defense system, and induces oxidative stress.

Bone mineral density in premenopausal women with major depression.

AIM: To investigate the relationship between the major depression and bone mineral density (BMD) in premenopausal women. MATERIAL AND METHODS: We compared BMD, plasma cortisol level, osteocalcin and C-telopeptide levels of 35 premenopausal women with major depression with those of 30 healthy women who were matched for age and body mass index. Major depression was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders (fourth edition) criteria. Nineteen patients had mild and 16 patients had moderate severity of major depression as measured by Hamilton rating scale for depression. RESULTS: Women with any risk factor for osteoporosis were excluded from the study. All women underwent BMD measurement by DEXA at lumbar (L2-4) and femoral neck region. After an overnight fasting, plasma cortisol levels were measured at 08:00 h by using competitive immunoassay method. Osteocalcin and C-telopeptide were used for the evaluation of bone turnover. There were no significant differences in BMD, plasma cortisol level, osteocalcin and C-telopeptide levels between the patients and the control groups. There was also no correlation between the plasma cortisol level, the duration and the severity of disease, antidepressant drug use and BMD. CONCLUSION: Major depression had no significant effect on BMD and bone turnover markers in our patient group of mild to moderate severity of the disorder.

Free radicals and antioxidants in primary fibromyalgia: an oxidative stress disorder?

The role of free radicals in fibromyalgia is controversial. In this study, 85 female patients with primary fibromyalgia and 80 age-, height-, and weight-matched healthy women were evaluated for oxidant/antioxidant balance. Malondialdehyde is a toxic metabolite of lipid peroxidation used as a marker of free radical damage. Superoxide dismutase is an intracellular antioxidant enzyme and shows antioxidant capacity. Pain was assessed by visual analog scale. Tender points were assessed by palpation. Age, smoking, body mass index (BMI), and duration of disease were also recorded. Malondialdehyde levels were significantly higher and superoxide dismutase levels significantly lower in fibromyalgic patients than controls. Age, BMI, smoking, and duration of disease did not affect these parameters. We found no correlation between pain and number of tender points. In conclusion, oxidant/antioxidant balances were changed in fibromyalgia. Increased free radical levels may be responsible for the development of fibromyalgia. These findings may support the hypothesis of fibromyalgia as an oxidative disorder.

The effect of hand osteoarthritis on grip and pinch strength and hand function in postmenopausal women.

The aim of the study was to investigate the effect of osteoarthritis on hand function in postmenopausal women. One hundred patients with hand OA and 70 healthy volunteers as controls were evaluated. Grip and pinch strength measurements and Dreiser's functional index were used for hand function. Pain was assessed by a visual analog scale, and tenderness was assessed by palpation and scored, depending on the severity of tenderness, as 0, 1 or 2. Heberden's and Bouchard's nodules and joint involvement were also recorded. The number of patients with only distal interphalangeal joint involvement was 50 (50%), those with distal interphalangeal joint plus proximal interphalangeal joint involvement was 49 (49%), and those with carpometacarpal joint involvement numbered 18 (18%). The incidence of Heberden's and Bouchard's nodules was 85% and 36%, respectively. Eighty-six (86%) patients were suffering from pain and 57 were found to have tenderness. Grip and pinch strength was significantly lower (p<0.05) and Dreiser's functional index score was significantly higher (p<0.001) in the study group (particularly in grade 4 OA). Grip strength was lower in hand OA patients with distal interphalangeal joint plus proximal interphalangeal joint involvement than in those with only distal interphalangeal joint and carpometacarpal joint involvement. Pinch strength was also lower in patients with distal interphalangeal joint plus proximal interphalangeal joint plus carpometacarpal joint involvement. The patients with Heberden's and Bouchard's nodules had lower grip and pinch strength than controls. Also, pain and tenderness had significant (p<0.05) effects on hand function. Dreiser's total score ranged from 0 to 10 in 80 (80%) patients and from 11 to 20 in 20 patients. In conclusion, hand osteoarthritis contributes to hand dysfunction, mainly related to the severity of osteoarthritis, pain, joint involvement and the presence of nodules.

Pulmonary function tests, respiratory muscle strength, and endurance of patients with osteoporosis.

BACKGROUND: It has been shown that patients with thoracic kyphosis due to osteoporosis have diminished pulmonary function. The aim of this study was to determine the pulmonary function, respiratory muscle strength, and endurance of patients with osteoporosis who did not have compression fractures. METHODS: The patient group consisted of 88 recently diagnosed postmenopausal osteoporotic women without spinal fractures. They were matched for age and body mass index with 54 healthy women, who formed the control group. Bone mineral density, pulmonary function test (PFT), maximum voluntary ventilation (MVV), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP) measurements of both groups were performed. RESULTS: There were no significant differences between the two groups regarding PFT parameters and MIP and MEP. However, osteoporotic patients had significantly lower MW values. CONCLUSION: Women with postmenopausal osteoporosis without spinal compression fractures have normal PFT, MIP, and MEP values, but they have reduced respiratory muscle endurance.

Bone mineral density and grip strength in postmenopausal Turkish women with osteoporosis: site specific or systemic?

OBJECTIVE: To assess the relationship of grip strength to site-specific bone mineral density of the metacarpal bone and also axial bone mineral density. The bone mineral density of the lumbar spine, femoral neck and the nondominant hand were measured by DEXA. SUBJECTS: A total of 187 postmenopausal women were included in the study. Of the patients, 102 were osteoporotic, and 85 were not osteoporotic and served as control subjects. METHODS: Grip strength of the nondominant hand was measured by hand-held dynamometer. Skinfold thickness of the nondominant hand was measured by a caliper (Holstain). Biochemical markers of bone turnover and other osteoporosis-related variables were also measured. RESULTS: There was a statistically significant difference between groups regarding bone mineral density of the lumbar, femoral (neck) and hand regions and the grip strength (P < .05). Hand bone mineral density (BMD) was found to be correlated with bone mineral density of the lumbar and femoral (neck) regions in osteoporotic patients. Grip strength was correlated positively with the BMD of the nondominant hand. Grip strength was correlated negatively with age and years since menopause. Grip strength was also correlated positively with femoral neck BMD. CONCLUSION: The study provides support for a site-specific and also systemic relationship between muscle and bone. Grip strength is also a predictor of hand bone mineral density.

Unilateral brachial plexus injury occurring after reduction mammaplasty.

A left neuropraxic brachial plexus injury was seen after reduction mammaplasty. The clinical signs of plexopathy were noted in the very early postoperative period. The partial axonal damage was heavy in the upper and posterior branches and moderate in the medial branch of the plexus. The hyperabduction of the upper extremity during the surgery was thought to be the main cause. With a close followup and extensive physiotherapy, in addition to B complex vitamins, a full recovery was achieved at the end of the tenth week.

Acute electrophysiologic effect of pulsed gallium-arsenide low energy laser irradiation on configuration of compound nerve action potential and nerve excitability.

BACKGROUND AND OBJECTIVES: We evaluated the acute electrophysiologic effects of low-energy pulsed laser irradiation, measured by extracellular recording technique on compound action potential configuration and nerve excitability in the isolated frog sciatic nerve STUDY DESIGN/MATERIALS AND METHODS: A pulsed gallium-arsenide (GaAs) laser (wavelength, 904 nm; pulse duration, 220 nanoseconds; peak power per pulse, 27 W; spot size, 0.28 cm(2); total applied energy density, 0.005-2.5 J/cm(2)) was used for the experiment. Sixty isolated nerves were divided into six groups (n = 10), each of which received a different repetition frequency. In each group, action potentials were recorded, before laser irradiation, which served as the control data. The extracellular action potentials were recorded for each combination of 1, 3, 5, 7, 10, 13, and 15 minutes of irradiation time and 4, 8, 16, 32, 64, 128 repetition frequency by using a BIOPAC MP 100 Acquisition System Version 3.5.7 (Santa Barbara USA). Action potential latency, duration of depolarization and repolarization, and the stimulating voltage were measured. Statistical evaluation was performed using linear correlation analysis by SPSS 9.05. RESULTS: Although there was no correlation between applied energy density and action potential latency, the duration of depolarization and repolarization phases (P > 0.05), there was a weak correlation between applied energy density and stimulating voltage. CONCLUSIONS: The study showed that low-energy GaAs irradiation at 42 different energy density between 0.005 and 2.5 J/cm(2) generates no effect on action potential configuration and nerve excitability.

Electrophysiologic effect of gallium arsenide laser on frog gastrocnemius muscle.

BACKGROUND AND OBJECTIVE: In this study, the effect of low energy Gallium arsenide (GaAs) laser irradiation on the compound action potential of frog gastrocnemius muscle were investigated. STUDY DESIGN/MATERIALS AND METHODS: Sixty frogs were divided into different six dose groups: laser 1 (1 Hz), laser 2 ( 4 Hz), laser 3 (16 Hz), laser 4 (64 Hz), laser 5 (128 Hz), and laser 6 (1,000 Hz, DC, continue) (in each group n=10). Low energy GaAs laser (wavelenght: 904 nm, pulsed duration: 220 nanoseconds, peak power per pulse: 27 W, total applied energy density: 0.001-25.7 J/cm2) was used for the experiment. Compound muscle action potentials were recorded before laser irradiation and these data were accepted as control group. After recording the control data, each muscle was irradiated by the laser. Action potentials were recorded at 1, 5, 10, 15, and 20 minutes of irradiation time in each group by using standartized needle electromyography and nerve conduction study techniques. Distal motor latency, peak to peak amplitude, area, and total duration of action potential were measured. Repeated measures analysis of variance were used for the statistical evaluation. RESULTS: No significant differences were detected between control and laser dose groups in muscle action potential parameters. CONCLUSIONS: This study revealed that at the different repetition rate and exposure time, low energy GaAs laser does not have any significant effect on frog gastrocnemius action potential.

Study of axial bone mineral density in postmenopausal women with diffuse idiopathic skeletal hyperostosis related to type 2 diabetes mellitus.

OBJECTIVE: The association of bone mineral density (BMD) with diffuse idiopathic skeletal hyperostosis (DISH) related to diabetes mellitus was studied. METHODS: We measured BMD and elevated known determinants of BMD (bone markers) in 35 patients with DISH-related type 2 diabetes mellitus, 47 type 2 female diabetics, and 52 female controls with no systemic disease and no drug administration. All subjects were matched for age and body mass index (BMI). All subjects were in the postmenopausal period. RESULTS: Among subjects, BMD values were significantly higher in DISH patients than in diabetics and controls (p < 0.05). In addition, the duration of diabetes mellitus was longer in DISH patients and significantly correlated with total hip BMD in DISH patients (p < 0.05). CONCLUSIONS: Patients with DISH have higher BMD, and increased BMD probably results from hyperostosis of the axial skeleton, which may cause decreased fracture risk.

Correlation of serum cytokine levels with axial bone mineral density.

Cytokine has been postulated to play a role in the pathogenesis of post-menopausal osteoporosis. To test this hypothesis we measured circulating levels of IL-1, IL-6,IL-8 and TNF-alpha in 98 post-menopausal women (30 age matched normal and 68 osteoporotic) with no vertebral fractures. Although the cytokine levels of patients were found in normal cut off values, the difference in cytokine levels between patients and controls was statistically significant for IL-1 and IL-8 (p < 0.01). In osteoporotic patients, none of the cytokines correlated with lumbar, femoral (neck) and total hip bone mineral densities and also with body mass index (p > 0.01). In conclusion, we were unable to demonstrate abnormalities of cytokines affecting bone resorption in peripheral serum of women with post-menopausal osteoporosis. However increased production of these cytokines may occur in the local environment of bone.