Effects of Linagliptin and Pioglitazone on Fracture Healing in an Experimental Type 2 Diabetes Rat Model.

AIM: Our study aimed to examine the effects of Linagliptin, Pioglitazone, and their combination on fracture healing in a diabetes rat femur fracture model. MATERIAL AND METHODS: Type 2 diabetes mellitus (T2DM) induced rats were randomly divided into four groups: non-treated diabetes group (TD), Pioglitazone group (P), Linagliptin group (L), and Pioglitazone and Linagliptin group (PL). Daily oral dosage of pioglitazone (10 mg/kg/day), linagliptin (10 mg/kg/day), and their combination were administered. Femur fractures were stabilized intramedullary. At weeks 2 and 6, rats were sacrificed for evaluation radiologically, biomechanically, histopathologically, histomorphometrically, and immunohistochemically. RESULTS: Flexural strength of the L and PL groups were significantly higher compared to the P group. The highest healing score was in the L group and lowest in the P group, while the highest inflammation score was in the P group and lowest in the L group. A cluster of differentiation (CD) CD 34 reactivity was highest in the L group and lowest in the PL group. CONCLUSION: Linagliptin treatment significantly increased histological healing scores, callus volume, biomechanical strength, and vascularity, however, minimized the inflammatory process, which was increased by pioglitazone. The combination of linagliptin and pioglitazone restored BMD and increased biomechanical strength. Linagliptin monotherapy is rarely indicated; hence, T2DM patients with a high risk of bone fractures can be considered for combined therapy of pioglitazone and linagliptin.

Evaluation of Magnetic Resonance Findings of Circumventricular Organs in Idiopathic Intracranial Hypertension Patients.

BACKGROUND: Idiopathic intracranial hypertension (IIH) is the increased pressure with normal cerebrospinal fluid (CSF) composition, not due to a secondary cause. However, the need for lumbar puncture, an invasive method in diagnosis, leads to research on noninvasive diagnostic methods. This study aims to examine the role of the size of the pituitary gland and the previously unevaluated pineal gland in radiological diagnosis in patients with IIH. MATERIALS AND METHODS:  The study retrospectively included 57 patients aged 18-80 years, who were followed up in our clinic with the diagnosis of IIH, and 52 control patients without central nervous system disease and cranial MR pathology. CSF pressure measurement values, CSF biochemistry, and cytology examinations were recorded as a result of lumbar puncture performed in the lateral decubitus position of all patients. In addition, the pineal gland and pituitary dimensions were measured by a neuroradiologist on cranial MR imaging of both groups. RESULTS: Pituitary gland height, anteroposterior (AP), and transverse dimensions were found to be significantly lower in the IIH patient group than in the control group (p<0.05). There were a significant reduction in pineal gland AP and height measurements in the IIH patient group compared to the control group. Still, we found no significant difference between the two groups in transverse measurements (p>0.05). CONCLUSION:  Our findings suggest that measurement of pituitary and pineal gland sizes in neuroimaging may be a guide as a noninvasive method in diagnosing and treating IIH.

Prevalence and Radiological Characteristics of the Fabella in Turkish Population.

BACKGROUND: This study aimed to evaluate and analyze the prevalence and radiological characteristics of the fabella in the Turkish population, detecting differences between genders by examining magnetic resonance imaging (MRI) images of subjects. METHODS: A total number of 504 patients aged >18 years who were admitted to the orthopedics and traumatology clinic between November 2018 and October 2020 were included in this retrospective cross-sectional study. Bilateral MRI images that were taken from each patient were randomly selected. Age, sex, laterality (right or left knee), and size of the fabella were retrieved from institutional database records. P-value<0.05 is considered statistically significant. RESULTS: A total of 504 patients were included with 213 males and 291 females. The overall prevalence of fabella was 20.63%. The mean length, thickness, and width of the fabella were 6.05 mm, 4.63 mm, and 5.92 mm, respectively, in the overall population. The fabella was significantly wider, thicker, and longer in males compared to females in the Turkish population. CONCLUSION: This study revealed similar prevalence rates of the fabella in the Turkish population with Caucasian populations and similar size of the fabella in the Asian population. When different prevalence rates and sizes of the fabella among different ethnic populations are considered, it is critical to understand the prevalence or radiological features of the fabella in Turkish subjects to avoid misinterpretation of fabella diseases.

Effect of Weather Conditions on the Pediatric Supracondylar Humerus Fracture Incidence.

BACKGROUND: Some environmental factors pose as risk factors for children's supracondylar humerus fractures. This study aimed to evaluate the relationship between weather conditions and pediatric supracondylar humerus fracture incidence. METHODS: A total of 310 patients aged <16 years, admitted to our hospital with supracondylar humerus fractures, were evaluated. We evaluated patients' age, and also, season, day, and weather conditions. The Turkish State Meteorological Service database was used for meteorological data and data was analysed statistically. RESULTS: Most cases occurred in the spring (28.1%, n=87) and summer (27.1%, n=84). Cases of older children (aged six years and older) with supracondylar humerus fractures were recorded in the summer season, while fracture cases in preschool-aged (younger than six years old) children were seen in the winter season. CONCLUSION: We found that the overall incidence of pediatric supracondylar humerus fractures increased in spring and summer seasons. In addition, the fracture incidence in preschool- and school-aged children differed according to the season and temperature. Hence, the management of these fractures could also include the significance of weather conditions, making preventive measures more critical in the spring and summer seasons.

Segmental Zoster Paresis of the Unilateral Lower Extremity With Neuritis MRI Findings: A Case Report and Literature Review.

Herpes zoster (HZ) is a common clinical condition caused by the reactivation of the latent varicella-zoster virus (VZV). Neurological complications after HZ have been described, including a rare condition of segmental zoster paresis (SZP), which results in unilateral motor impairment in the extremities. Only two cases of HZ patients with radiculopathy and MRI findings of neuritis have been reported. We present a 62-year-old male with a HZ rash in the right calf and low back pain radiating to the right leg accompanied by a right leg great toe weakness for one week. Neurological examination revealed 4/5 dorsiflexion of the right great toe. Also, the patient's rash was distributed on the L5 dermatome. The lumbar MRI showed a contrast enhancement of the right L5 nerve root with enlargement diagnosed as neuritis. The patient was treated with valacyclovir. The neuromotor deficit and the cutaneous rash started to improve on the third day of treatment. This case emphasizes the necessity of considering SZP in the differential diagnosis of elderly patients presenting with muscle weakness in the lower extremity with or without a rash. MRI evaluations of HZ patients with radiculopathy may include contrast-enhanced sequences.

Anterior-to-Posterior Epidural Migration of a Lumbar Disc Herniation at L1-L2: A Case Report.

Protruded disc fragments that penetrate the posterior longitudinal ligament (PLL) migrate rostral or caudal in the vertical plane, some laterally in the horizontal plane, or into the foramina involving the anterior aspect of the spinal canal. Often, there is migration to the ventral epidural space. However, posterior epidural migration of a lumbar disc herniation (PEMLDH) is a rare phenomenon that makes the differential diagnosis challenging. We describe a rare case of anterior-to-posterior epidural migration of a lumbar disc herniation at the L1-L2 level. It was treated microsurgically after total laminectomy, and total resection of the lesion was carried out. PEMLDH is a unique condition causing neurological deficits at different levels. Due to different localization of disc herniations, optimal diagnosis becomes critical for determining the timing and type of treatment surgically.

The Terrible Triad of the Elbow Accompanied by Capitellum and Humerus Shaft Fracture: A Rare Case Report.

The terrible triad of the elbow consists of radial head fracture and coronoid process fracture in addition to posterior dislocation of the elbow. It indicates high-risk complications such as instability, malunion, nonunion, and proximal radioulnar synostosis. We describe a rare case that was admitted to the emergency service with a terrible triad of the elbow with additional capitellum fracture, lateral collateral ligament (LCL) injury, and ipsilateral humeral shaft fracture. We treated the patient urgently by performing osteosynthesis of the humeral shaft fracture, radial head fracture, coronoid fracture, capitellum fractures, and repair of the LCL rupture. The terrible triad of the elbow also can be accompanied by adjacent column fractures, including the humeral shaft. In such complex cases, preoperative planning should be done well, and the entire anatomy should be demonstrated with additional imaging. Optimal treatment of all the fractured bones and ligaments is critical for early rehabilitation. The main aim of surgery is to acquire desired results by starting an early rehabilitation, including joint movement.