Anatomical medial patellofemoral ligament reconstruction improves sport participation and activity levels in adolescents with recurrent patellar dislocation.

OBJECTIVES: This study aims to evaluate the clinical outcomes of an anatomical medial patellofemoral ligament (MPFL) reconstruction and the effects of concomitant patellofemoral joint injuries and radiological findings on outcomes in adolescents with recurrent patellar dislocation (RPD). PATIENTS AND METHODS: Between January 2011 and January 2020, a total of 34 patients (19 males, 15 females; median age: 15.6 years; range, 13 to 17 years) with RPD who underwent anatomic MPFL reconstruction were retrospectively analyzed. Lateral release was performed as indicated. Clinical outcomes were evaluated preoperatively and at the final follow-up using the Visual Analog Scale (VAS), Lysholm, Kujala, and Tegner activity rating scales. Magnetic resonance imaging was performed to detect concomitant injuries such as bone, cartilage, and soft tissue injuries. RESULTS: The mean follow-up was 5±2 years. All postoperative knee functions and activity levels were statistically significantly improved without re-dislocation (p<0.001). There was no statistically significant relationship between the presence and location of cartilage lesions and clinical outcomes (p>0.05). Patients with cartilage lesions had a significantly higher CatonDeschamps index and a higher incidence of bone edema in both the patella and femur than patients without. CONCLUSION: Anatomic MPFL reconstruction with meticulous physical therapy has successful clinical outcomes, prevents re-dislocation, and increases participation in sports and activity levels in adolescent patients with RPD. Although cartilage injuries are common after RPD, it has no adverse effect on clinical outcomes in the mid-term.

Impact of open bursectomy and biceps tendon release with closed manipulation in frozen shoulder.

This retrospective observational study evaluated the efficacy of 2 different surgical approaches for the treatment of frozen shoulder (adhesive capsulitis). This study aimed to compare the efficacy, safety, and recovery times of the 2 treatment modalities. Fifty patients diagnosed with frozen shoulder and treated at Seyhan State Hospital were included in the study. The patients were retrospectively divided into 2 groups based on the treatment received. Group 1 consisted of 25 patients who underwent standard closed manipulation under anesthesia, a technique involving passive movements of the shoulder joint to tear the tight capsule and expand the range of motion (ROM). Group 2, which included 25 patients, underwent closed manipulation in addition to open bursectomy and biceps tendon capsule release. Open bursectomy involves surgical removal of the bursa to alleviate inflammation, while biceps tendon capsule release addresses chronic biceps tendonitis by partially removing the capsule of the tendon. Data on demographic information, operative details, preoperative and postoperative conditions, and patient-reported outcomes were collected and analyzed. Data analysis revealed that the combination of closed manipulation with open bursectomy and biceps tendon capsule release was more effective in reducing pain, increasing ROM, and improving quality of life than closed manipulation alone. The discussion would typically elaborate on how the results compare with existing literature, the clinical implications, and any potential limitations of the study. The results showed that the method that combined closed manipulation with open bursectomy and biceps tendon capsule release was better than closed manipulation alone in terms of reducing pain, increasing ROM, and improving quality of life.

Quality and comprehensiveness of YouTube videos on back pain during pregnancy.

OBJECTIVES: Back pain during pregnancy is a common issue that impacts the quality of life for many women. YouTube has become an increasingly popular source of health information. Pregnant women often turn to YouTube for advice on managing back pain, but the quality of available videos is highly variable. This study aimed to assess the quality and comprehensiveness of YouTube videos related to back pain during pregnancy. METHODS: A YouTube search was conducted using the keyword "back pain in pregnancy", and the first 100 resulting videos were included in the study. After a thorough review and exclusion of ineligible videos, the final sample consisted of 71 videos. Various parameters such as the number of views, likes, viewer interaction, video age, uploaded source (healthcare or nonhealthcare), and video length were evaluated for all videos. RESULTS: Regarding the source of the videos, 44 (61.9%) were created by healthcare professionals, while 27 (38%) were created by nonprofessionals. Videos created by healthcare professionals had significantly higher scores in terms of DISCERN score, Journal of the American Medical Association (JAMA) score, and Global Quality Scale (GQS) (P < 0.001). Our findings indicate a statistically significant and strong positive correlation among the three scoring systems (P < 0.001). CONCLUSION: Videos created by healthcare professionals were generally of higher quality, but many videos were still rated as low-moderate quality. The majority of videos focused on self-care strategies, with fewer discussing other treatment options. Our findings highlight the need for improved quality and comprehensiveness of YouTube videos on back pain during pregnancy.

Evaluation of 25(OH) vitamin D3 and quadriceps strength correlation in postmenopausal women: A cross-sectional study.

BACKGROUND: Vitamin D deficiency is common in postmenopausal women and is associated with low vitamin D intake, increased age, decreased absorption. Especially at advanced age, vitamin D deficiency may increase muscle weakness and disbalance resulting in increased risk of fracture. OBJECTIVES: This study aims to explore the correlation between 25(OH) vitamin D3 levels and quadriceps muscle strength in postmenopausal women. METHODS: We evaluated bilateral qadriceps muscle strength in postmenopausal women with isokinetic test. We evaluated the correlation of muscle power with measurements of parathormone, vitamin D, Calcium, creatinine, alanine transaminase, alkaline phosphatase, total creatine kinase. RESULTS: The mean vitamin D level of 95 participants included in the study was 18.24 ± 8.94 ng/ml. Vitamin D levels were found to be deficient (< 10 ng/ml) in 23 (24.1%), insufficient in 62 (65.26%) and normal in 10 (10.53%) of the 95 participants. A weak negative correlation was observed between participants' vitamin D levels and PT values (r=-0.271, p= 0.012). A moderate negative correlation was found between ALP and vitamin D levels (r=-0.317, p= 0.002). However, there was no significant correlation between vitamin D levels and the 60∘ and 90∘ flexion and extension peak torque values (All p values > 0.05). CONCLUSIONS: Vitamin D levels and muscle strength weren't statistically significant. Few studies are available in the related literature, highlighting the need for further research to achieve a clearer consensus.

Acute Respiratory Distress Syndrome Management in Pediatric Intensive Care Units in Turkey: A Prospective Survey.

OBJECTIVE: This study aimed to explore the compliance of management strategies for pediatric acute respiratory distress syndrome in pediatric intensive care units in Turkey with current guidelines. MATERIALS AND METHODS: This is a cross-sectional, prospective survey study. We delivered the survey, consisting of questions on topics in the relevant literature on acute respiratory distress syndrome management in children (1 month-18 years), to the heads/staff of the 100 units via email or phone. RESULTS: In total, 51 (51%) out of 100 targeted pediatric intensive care units responded to the survey. We found out that 17 (33%) units comply with no acute respiratory distress syndrome guideline, while 65% frequently utilize cuffed endotracheal tubes. The majority of the units (86%) achieve their mechanical ventilation targets with the help of pressure control modes. Besides, steroid and surfactant use are present in 47% and 45% of the units, respectively, while 16% and 38% of the units use inhaled nitric oxide and high-frequency oscillatory ventilation, respectively. CONCLUSION: Lung-protective ventilation strategies preventing ventilator-associated lung injury are explicit in all responding units. The present survey revealed that current mechanical ventilation and non-ventilation treatment strategies in pediatric ARDS in Turkey are relatively uniform and largely consistent with international practices.

Comparison of the clinical and sonographic effects of ultrasound therapy, extracorporeal shock wave therapy, and Kinesio taping in lateral epicondylitis

Background/aim: The aim of this study was to compare the clinical and sonographic effects of the ultrasound (US) therapy, extracorporeal shock wave therapy (ESWT), and Kinesio taping (KT) in the lateral epicondylitis (LE). Materials and methods: A total of 40 patients with LE were included in the present study. The patients were randomly assigned to 3 treatment groups: US (n = 13), ESWT (n = 14), and KT (n = 13) groups. Results: The visual analog scale (VAS) scores significantly decreased in all groups (P < 0.05). Grip strength significantly increased after 8 weeks in only the KT group (P < 0.05). The Patient-Rated Tennis Elbow Evaluation Scale (PRTEE) scores significantly decreased after 2 weeks and after 8 weeks in the US group and ESWT groups, and after 8 weeks in the KT group (P < 0.05). Common extensor tendon (CET) thicknesses significantly decreased after 8 weeks in only the ESWT group (P < 0.05). Conclusion: The US therapy, KT, and ESWT are effective in reducing pain and improving functionality. However, none of these treatment methods were found to be superior to others in reducing the pain and improving functionality.

Use of Tacrolimus During Pregnancy After Kidney Transplantaion.

PURPOSE: Motherhood is the greatest privilege that nature gives to women. Although pregnancy is a physiological event for women, every pregnancy is a risky pregnancy. During a normal pregnancy, the health of mother and baby are monitored. In post-transplantation pregnancies, the function of the transplanted organ, along with the mother and the infant, must be monitored, since the continuation of pregnancy depends on both the maternal and infant health and an organ functioning within normal limits. The desire is for every baby to be born in due time and at normal weight, but this is not always possible in pregnancies after transplants. Publications about the pharmocokinetics of tacrolimus are very limited. In this study, we wanted to share our experiences with pregnancy in our clinic. MATERIAL AND METHOD: Patients who used tacrolimus during their pregnancies after renal transplantation (RT) at Antalya Medicapark Organ Transplantation Unit, during November 2008 to July 2018 were included in the study. Patient's gestational age, pregnancy, drug levels, is charge, and labor creatinine clearances were examined. FINDINGS: Four thousand six hundred thirty-five RT occurred between November 2008 to July 2018; 786 of the patients were female between the ages 18 and 45. Thirty-one pregnancies went full term. Twenty-six pregnant women, who used tacrolimus after RT, were included in the study. Five patients had pre-eclampsia, 1 patient had abortus immines, 2 patients had hypertansion due to pregnancy, and 1 patient had aplated placenta. There was a breech presentation in 1 patient with preeclampsia. Acute rejection developed in 3 postpartum patients, but renal values normalized with medical treatment. All the babies were born alive and healthy; postpartum graft loss was not observed. CONCLUSION: If planning to become pregnant after RT,our center recommends waiting at least 2 years after the RT, when graft function should be normal and without any signs of HT and proteinuria. Our recommendation regarding the level of tacrolimus after RT is 4.5 to 7 µg.

Primary malignant melanoma of the maxillary gingiva.

BACKGROUND: Mucosal malignant melanoma arising from the mucosa of the head and neck region is a rare entity, accounting for approximately 0.2% of all melanomas. Most of these lesions (80%) have occurred on the maxillary anterior gingival area, especially on the palatal and alveolar mucosa. OBJECTIVE: Mucosal malignant melanomas are more aggressive than cutaneous melanomas. On the other hand, complex anatomy of this area makes complete surgical excision difficult. Thus, early diagnosis and treatment are important. METHODS: We presented primary malignant melanoma of the maxillary gingiva in two cases. CONCLUSION: In mucosal malignant melanoma, survival rates may be increased by early diagnosis and treatment. The clinician must carefully examine oral cavity, and pigmented lesions should be biopsied. Because some melanomas may be amelanotic, a high index of suspicion is necessary.