Risk factors for false positive and false negative MRI in diagnosing medial and lateral meniscal tears with concomitant ACL injury.

OBJECTIVE: To determine the diagnostic performance of MRI in evaluating meniscal abnormalities in the setting of anterior cruciate ligament (ACL) injury and recognize predictors of false positive (FP) and false negative (FN) MRI diagnosis. MATERIAL AND METHODS: Four hundred twenty patients (mean age, 27.2 years; 326 males, 94 females) who underwent arthroscopy for ACL injury between January 2017 and August 2022, and had preoperative imaging within 4 months, were retrospectively included. Images were independently interpreted by two experienced musculoskeletal radiologists, noting the presence of medial and lateral meniscal tears including tear type and location. Results were correlated with arthroscopic findings. Multivariate logistic regression was implemented to study risk factors (RF) for FP and FN MRI diagnosis. RESULTS: The sensitivity/specificity/positive predictive value/negative predictive value/accuracy of MRI for medial meniscus tear was 97.5%/74.46%/65.63%/98.35%/82.15%; for lateral meniscus tear, it was 83.5%/93.70%/70.8%/94.55% /87.86%, with substantial interreader agreement. Female gender (odds ratio (OR), 0.434), posterior horn and posterior root tears (OR, 3.268/22.588), horizontal tear (OR, 3.134), and ramp lesion (OR, 4.964) were found RF for FP medial meniscus, and meniscal body tears (OR, 308.011) were found RF for FP lateral meniscus. RF for FN medial meniscus were meniscal tear at the posterior horn, body, and posterior root (OR, 12.371/123.000/13.045). CONCLUSION: MRI is an effective screening tool for meniscal tears, but less accurate in detecting all medial meniscus injuries. Gender, meniscal tear location, and type increased the risk of FP medial meniscal tear on MRI, while meniscal tear location increased the risk of FP lateral meniscus and FN medial meniscus tears.

The gracilis and semitendinosus muscles: a morphometric study on 18 specimens with clinical implications.

INTRODUCTION: The pes anserinus consists of the sartorius, semitendinosus, and gracilis muscles. They coalesce together with the leg fascia to form the anserine plate. The semitendinosus and gracilis both form the deep layer of this plate and are clinically relevant for ligament reconstruction. The aim of the study is to report a detailed morphometric evaluation of the semitendinosus and gracilis muscles and assess their clinical implications. METHODS: Using a rigorous dissection process on 18 cadaveric hips, measurements of both the semitendinosus and gracilis muscles with bone parameters were conducted. We measured the following: (a) total femur, femoral shaft, and neck lengths, (b) total muscle lengths, and (c) intra-muscular and extra-muscular (free) tendon lengths. Correlation values between bone variables, muscle variables, and in-between muscle variables were computed. RESULTS: The total muscle and the distal intra-muscular tendon length of the St and Gr are correlated with the total femur length. When compared to gracilis, the total muscle and distal intra-muscular tendon lengths of the ST are much better correlated with the total femur length. The free distal tendon length for both muscles did not show a significant correlation with any of the femoral bone lengths. CONCLUSION: The variability of tendon length of the ST/Gr poses a significant challenge to surgeons. This study reports a detailed morphometric evaluation of the ST/Gr hamstring muscle and tendons. It revealed a positive correlation between the femoral length and the ST/Gr graft lengths. This could help orthopedic surgeons in predicting the graft lengths pre-operatively and develop better planning for reconstructive surgeries.

Fetal acute cerebral vasoreactivity to maternal hyperoxia in low-risk pregnancies: a cross-sectional study.

OBJECTIVE: To establish whether fetal cerebral vasoreactivity (CVRO2 ), following maternal hyperoxia, is predicted by fetal cerebral and uteroplacental Doppler pulsatility indices (PI) at baseline, fetal pulmonary vasoreactivity to oxygen (PVRO2 ), gestational age (GA), or sex. METHODS: Pulsatility index of middle (MCA), anterior (ACA), posterior cerebral (PCA), umbilical (UA), uterine (UtA), and branch of the pulmonary arteries (PA) were obtained, by ultrasound, before (baseline), during (hyperoxia) and after 15 minutes of maternal administration of 8 L/min of 100% oxygen, through a non-rebreathing face mask, in normal singleton pregnancies within 20 to 38 weeks' gestation. CVRO2 was defined as changes greater than zero in z score of PI of the cerebral arteries from baseline to hyperoxia. Logistic modeling was applied to identify CVRO2 predictors. RESULTS: A total of 97 pregnancies were eligible. In the overall population, median z scores of PI of MCA, ACA, and PCA did not differ between study phases. Based on the logistic model, baseline z scores for cerebral PI and GA were the best predictors of CVRO2 . CONCLUSIONS: In low-risk pregnancies, fetal CVRO2 to hyperoxia does not occur uniformly but depends on cerebral PI and GA at baseline. These findings may provide useful reference points when oxygen is administered in high-risk pregnancies.

Lebanon's experience in surveillance of communicable diseases during a mass gathering: Sixth Francophone Games, 2009.

In 2009, Lebanon hosted the 6th Francophone Games. Pandemic A(H1N1)2009 virus presented significant health threat at the time. A surveillance strategy was implemented for the timely detection and management of epidemiological events and outbreaks, in particular for A(H1N1)2009 virus cases. Data were collected and managed daily and feedback was generated through daily bulletins. A total of 299 medical consultations were reported, 29% of which related to infectious diseases. There were 10 cases reported as acute respiratory infections; all tested negative for A(H1N1)2009 virus within 24 hours. Twenty-three cases of gastroenteritis were reported, for which 11 stool cultures were negative. While pandemic A(H1N1)2009 did not interfere with the Games, it was essential to strengthen surveillance and to have timely epidemiological information. This was achieved through preparedness, a multi-disciplinary approach, timely management and coordination.

Bilateral Quadriceps Tendon Rupture in a Healthy Individual Following a Motor Vehicle Accident: A Case Report.

Bilateral quadriceps tendon rupture (QTR) is a rare injury that typically affects middle-aged men presenting underlying medical conditions, while only a few cases have been reported in healthy individuals. The gold standard treatment of such injuries is prompt surgical repair, followed by postoperative immobilization and physiotherapy. We present the case of a 51-year-old previously healthy man who experienced bilateral, simultaneous, and complete QTR following a high-velocity motor vehicle accident. Physical examination revealed bilateral extensor mechanism disruption and palpable defects at the superior poles of the patellae. MRI confirmed the diagnosis, and the patient underwent surgical repair using three anchor sutures on each side. Postoperative management involved a brief period of immobilization followed by progressive passive motion exercises and protected weight bearing. At a six-month follow-up, the patient had excellent functional outcomes and was satisfied with the treatment.

Bridge enhanced ACL repair vs. ACL reconstruction for ACL tears: A systematic review and meta-analysis of comparative studies.

INTRODUCTION: Anterior cruciate ligament (ACL) tear is one of the most frequent ligamentous injuries. The gold standard for ACL tears is autograft reconstruction. However, ACL repair has regained enthusiasm with more recent results showing comparable outcomes to its reconstructive counterpart. METHODS: PubMed, Cochrane, and Google Scholar (pp. 1-20) were searched until November 2022. The clinical outcomes consisted of the International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), the side-to-side difference in Anteroposterior (AP) knee laxity, the forces of the hamstring, quadriceps, and hip abduction as well as hopping tests. RESULTS: Only two studies were included in this meta-analysis. ACL repair was shown to have better Hamstrings strength. The rest of the analyzed outcomes were comparable. DISCUSSION: This is the first meta-analysis comparing these two treatments. The ACL repair showed no differences in muscle strength (quadriceps and hip abductors), postoperative knee scores, and knee joint laxity when compared to ACL reconstruction. However, it showed better hamstring strength. Further randomized clinical studies will be needed to compare both of these techniques.

An isolated rupture of the anterolateral ligament of the knee: A case report.

INTRODUCTION: The anterolateral ligament (ALL) is a controversial ligament in the knee that may play a significant role in knee stability. It is difficult to identify on magnetic resonance imaging (MRI) imaging and is often injured in conjunction with other ligaments, such as the anterior cruciate ligament (ACL) and medial collateral ligament. CASE PRESENTATION: This is a unique case of an isolated ALL tear in a 48-year-old woman who presented with severe left knee pain, swelling, and inability to bear weight during a yoga session. Physical examination showed swelling and tenderness at the lateral aspect of the femoral condyle, with increased pain on varus stress testing. Radiographs revealed normal osseous structures with the absence of traumatic bone lesions. MRI revealed an intact meniscus, cruciate, and collateral ligaments, but a rupture of the ALL at its femoral origin. Diagnosis of isolated ALL rupture of the left knee was made, and the patient was treated conservatively with icing, rest, and non-steroidal anti-inflammatory drugs. Physiotherapy was started 2 weeks post-injury, and return to sports was allowed at the sixth week. Upon last follow-up, the patient had excellent functional outcomes and was satisfied with the treatment. Physical examination showed a stable knee with negative Lachman and pivot shift tests. To the best of the authors' knowledge, this is the first case of isolated ALL rupture to be reported. DISCUSSION: The paper highlights the rarity of isolated ALL injuries and the difficulty in diagnosing them. Conservative treatment can be successful for isolated ALL injuries, with physiotherapy playing an essential role in rehabilitation.In conclusion, isolated ALL injuries are rare and can be challenging to diagnose. Conservative treatment with physiotherapy can lead to successful outcomes. Further research is needed to understand the role of the ALL in knee stability and to determine optimal treatment options.

Semimembranosus Tendon Entrapment by an All-Inside Meniscal Suture.

Meniscal suturing has become the gold standard when it comes to meniscal tears in vascularized areas, especially in the younger population. The all-inside meniscal suturing technique has gained popularity in the past year due to decreased operative time as well as decreased risk of adverse events, as compared to other modalities. However, several complications have been reported with the all-inside technique, including soft tissue and neurovascular injury. This is the first case reporting a semimembranosus tendon entrapment following an all-inside medial meniscal suture. Being aware of such complications is crucial in order to avoid them and treat them promptly should they arise.

Pharmacological treatment in pregnant women with moderate symptoms of coronavirus disease 2019 (COVID-19) pneumonia.

OBJECTIVE: Pregnant women with moderate symptoms of COVID-19 are at risk for progressing to severe or critical illness. While there are limited data on the management of severe COVID-19 during pregnancy, information on pharmacological treatments of moderate COVID-19 is lacking. We report clinical outcomes of pregnant women hospitalized due to moderate COVID-19 illness treated with a 5-day course of remdesivir, antibiotics, and/or glucocorticoids. MATERIALS AND METHODS: Case series of pregnant women hospitalized with moderate symptoms of COVID -19 pneumonia at two INOVA Health System hospitals from April 1 to December 31, 2020. Primary outcome was clinical recovery (breathing on ambient air and/or hospital discharge) on hospital day 7 (HD7). Cox regression analysis was performed to evaluate which variables were associated with the primary outcome. RESULTS: Out of 748 pregnant women with confirmed infection by reverse transcriptase polymerase chain reaction, 35 were hospitalized due to moderate symptoms of COVID-19 pneumonia (median gestational age 29 weeks). There was no maternal death. Seventeen patients received remdesivir within 48 hours of hospitalization: 15 remained with moderate symptoms and 2 (who also received glucocorticoids) had progressed to critical COVID-19 at remdesivir initiation; all 17 women in this group achieved clinical recovery on HD7. Seven women received remdesivir >48 hours following admission after they began treatment with glucocorticoids ± antibiotics and worsened to severe or critical disease; they all required supplemental oxygen on HD7. Eleven women were treated with antibiotics ± glucocorticoids but no remdesivir; on HD7, 3/11 achieved clinical recovery. Clinical recovery was significantly different among treatment groups; p < 0.001. When analyzing only women who remained with moderate symptoms at pharmacological treatments initiation, all 15 on remdesivir and only 3 of 11 on antibiotics achieved clinical recovery on HD7; p < 0.001. Delaying remdesivir for >48 hours after admission (HR 2.32, 95% CI 1.45-4.16) and >4-day duration of symptoms prior to hospitalization (HR 1.65, 95% CI 1.27-3.50) had an inverse association with clinical recovery. Incidental oligohydramnios was seen in 3/24 (12.5%) of women within 5 days of completing remdesivir treatment. Elevated transaminases was prevalent in women treated with remdesivir (8/24, 33.3%). CONCLUSION: In our cohort, prompt initiation of remdesivir in pregnant women hospitalized with moderate symptoms of COVID-19 pneumonia within 48 hours of admission prevented worsening and allowed a fast clinical recovery by HD7. Deferring remdesivir for >48 hours after hospitalization and duration of symptoms >4 days before admission were independently associated with delayed clinical recovery and longer hospital admission. Ultrasound evaluation of the amniotic fluid in patients recovering from COVID-19 hospitalization should be considered.

Structured Teaching of Early Pregnancy Loss Counseling.

OBJECTIVE: To estimate whether a novel structured curriculum could significantly improve medical student performance in early pregnancy loss counseling. BACKGROUND: Medical students receive limited exposure to early pregnancy loss counseling through real-life observation of this important skill. METHODS: A pre-post control group design was used to examine early pregnancy loss counseling performance among medical students from two medical schools doing their obstetrics and gynecology rotations at the same community hospital. The study outcomes were: (1) pre-post differences in Standardized Patient Objective Structured Clinical Examination scores; (2) pre-post differences in student confidence levels; and (3) postdifferences in standardized patient empathy ratings. Both groups had similar demographics, academic parameters, and longitudinal curricula. The study group (N=39) received a curriculum of demonstration and role-playing for delivering bad news and a shared decision-making model for early pregnancy loss management. The control group (N=38) received traditional instruction. RESULTS: Standardized Patient Objective Structured Clinical Examination posttest scores were significantly higher for the study group compared with the control group (94.2% compared with 69.7%, P<.001) after starting with similar pretest scores (64.0% compared with 61.6%, P=.53). Posttest confidence levels (1=high, 5=low) were significantly higher for the study compared with the control group (1.57 compared with 3.62, P<.001) after starting at similar levels (4.27 compared with 4.23, P=.79). Standardized patient empathy ratings (1=high, 5=low) were significantly higher for the study compared with the control group (1.84 compared with 2.62, P=.002). CONCLUSION: A structured curriculum for teaching early pregnancy loss counseling improved student performance on standardized Objective Structured Clinical Examinations compared with traditional instruction. Providing these counseling tools improved their confidence and empathy ratings in caring for patients with early pregnancy loss.

Subtle adverse effects of late preterm birth: a cautionary note.

OBJECTIVE: Late preterm birth increases risk of perinatal health complications that typically resolve in the short term. Thus, early elective delivery is thought to have no long-term effects. Whether there is increased risk of adverse psychological outcomes that emerge in early childhood remains uncertain. METHOD: The authors compared intellectual, neuropsychological, and behavioral outcomes in 278 late preterm (35-36 weeks) and 192 term (37-41 weeks) participants at age 3 years recruited from a single center, using analysis of variance, analysis of covariance, and regression analyses. Late-preterm participants were further subgrouped by admission to the neonatal intensive care unit (NICU; n = 202) or a well-baby unit (n = 76). Analyses included 132 additional participants born at 34 weeks. RESULTS: Late preterm participants had lower general conceptual ability (GCA; i.e., IQ); lower verbal, nonverbal, spatial, visuomotor, and dexterity scores; and poorer adaptability than term participants (p < .01; -0.271 to -0.511 SDs). Gestational age was the most important predictor of these subtle outcomes, not neonatal medical variables; no differences were found between NICU admitted and nonadmitted late-preterm groups. A 1-week increase in gestational age resulted in a 1.941 increase in GCA (d = 0.127). CONCLUSION: Gestation is a developmental continuum best not interrupted during its natural course. Our data showing subtle but appreciable effects have important implications for obstetric practice and parental decision making regarding early elective delivery in the absence of maternal or fetal adverse indications.

Lebanon's experience in surveillance of communicable diseases during a mass gathering: Sixth Francophone Games, 2009

In 2009, Lebanon hosted the 6th Francophone Games. Pandemic A[H1N1]2009 virus presented significant health threat at the time. A surveillance strategy was implemented for the timely detection and management of epidemiological events and outbreaks, in particular for A[H1N1]2009 virus cases. Data were collected and managed daily and feedback was generated through daily bulletins. A total of 299 medical consultations were reported, 29% of which related to infectious diseases. There were 10 cases reported as acute respiratory infections; all tested negative for A[H1N1]2009 virus within 24 hours. Twenty-three cases of gastroenteritis were reported, for which 11 stool cultures were negative. While pandemic A[H1N1]2009 did not interfere with the Games, it was essential to strengthen surveillance and to have timely epidemiological information. This was achieved through preparedness, a multi-disciplinary approach, timely management and coordination

En 2009, le Liban a accueilli la sixième édition des Jeux de la Francophonie. Le virus pandémique A[H1N1] 2009 représentait une menace sanitaire majeure à l'époque. Une stratégie de surveillance a été mise en place en vue d'une détection et d'une prise en charge rapides des événements épidémiologiques et des flambées, notamment de cas de virus A[H1N1]2009. Les données ont été collectées et gérées sur une base journalière, et une rétroinformation était générée au moyen de bulletins quotidiens. Un total de 299 consultations médicales a été rapporté, dont 29% en rapport avec des maladies infectieuses. Dix cas d'infections respiratoires aiguës ont été notifiés. Tous se sont révélés négatifs au test de recherche du virus A[H1N1] 2009 réalisé sous 24h. Vingt-trois cas de gastroentérite ont été signalés, pour lesquels 11 coprocultures se sont révélées négatives. Si la pandémie A[H1N1] 2009 n'a pas impacté les Jeux, il était essentiel de renforcer la surveillance et de mettre en place un système d'information épidémiologique rapide. Ces objectifs ont été atteints au moyen d'une préparation, d'une approche multidisciplinaire, ainsi que d'une prise en charge et d'une coordination rapides

Demographic and obstetric factors influencing pregnancy outcome in twin gestations.

OBJECTIVE: Our purpose was to identify the influence of parity and previous preterm delivery on pregnancy outcome in twin gestations. STUDY DESIGN: A retrospective comparative analysis of women with twin gestations completing an outpatient preterm labor surveillance program between April 1995 and February 2000 was performed. Included were those enrolled at <24 weeks' gestation. Parity, maternal age, prepregnancy body mass index (BMI), cerclage, tocolytic use, and pregnancy outcome were identified. Data were divided into nulliparas, multiparas without previous preterm delivery, and those with previous preterm delivery. Analysis of variance and the Pearson chi2 test were used for statistical analysis. RESULTS: Data were analyzed for 1268 twin pregnancies. The mean gestational age at delivery for the multiparous women without a history of previous preterm delivery (35.3 +/- 2.7 weeks) was significantly greater than the mean gestational age at delivery for nulliparous (34.4 +/- 3.2 weeks) and multiparous women with a previous preterm delivery (34.0 +/- 3.1 weeks), P <.001. The greater gestational age at delivery in the multiparous women without a previous preterm delivery was associated with a significantly shorter newborn hospital stay and a lower need for mechanical ventilation use compared with the other groups (all P values < or =.001). CONCLUSION: In twin gestations, multiparous women without history of previous preterm delivery have a significantly greater gestational age at delivery, a lower incidence of cerclage, and a reduced neonatal hospital stay than do nulliparous women or those with a history of a previous preterm delivery.