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Patellofemarol Ağrı Sendromu ve Güncel Tedavi Yaklaşımları
No full textPatellofemoral ağrı sendromu (PFAS) patellofemoral eklemde (PFE) yüklenme oluşturan aktiviteler ile
provoke olan, patella çevresinde ve arkasında ağrı tariflenen, diğer ayırıcı patolojilerin yokluğunda bahsedilen, diz önünde ısrarcı ağrıya sebep olan kronik bir kas iskelet sistemi problemi olarak tanımlanmaktadır. Çömelme, uzun süreli dizler fleksiyonda oturma ve merdiven inme ve çıkma gibi PFE’ye yük bindiren
aktiviteler sırasında ve sonrasında artan bir ağrı söz konusudur. Ortopedi ve travmatoloji, spor hekimliği,
ortopedik ve sportif rehabilitasyon kliniklerine ön diz ağrısı ile başvurunun en sık karşılaşılan sebebidir. Görülme sıklığını araştıran kısıtlı sayıda çalışma bulunmasına rağmen PFAS alt ekstremitedeki en sık rastlanan ağrı nedeni olarak gösterilmektedir. PFA’nın tüm toplumu etkileyebildiği düşünülmekle beraber özellikle adolösanlar, genç aktif yetişkinler, elit atletler, askeri personelde ve yüksek insidans ve prevelans ile
kadınlarda görülmektedir. PFAS’ın güncel tedavisinde fizyoterapinin önemli bir rol oynadığı konservatif
tedaviye odaklanılmaktadır. Fizyoterapi PFAS’taki disfonksiyonun yönetilmesinde ve hastalar tarafından
deneyimlenen ağrının azaltılmasına sıklıkla başvurulan bir tedavi yöntemidir ve ağrıyı azaltmak ve diz fonksiyonunu geliştirmek için egzersiz yaklaşımlarını ön planda tutar. Konservatif tedavinin en büyük amacı
patellayı optimal bir biyomekanik dizilime getirmek ve diz çevresi kas yapısının tekrardan güçlenmesini
sağlamaktır. Tedavide sıklıkla egzersiz yoluyla PFE mekaniklerini geliştirme, bantlama, tabanlıklar, biyofeedback ve diğer adjuvan tedavilerle desteklenen kombine bir yaklaşım benimsenmektedir. Geleneksel
olarak quadriceps femoris kaslarında güç ve koordinasyon üzerinde duran diz odaklı egzersizler kullanılırken kalça odaklı egzersizler de son zamanlarda oldukça ilgi odağı haline gelmiş durumdadır.Patellofemoral pain syndrome (PFPS) is defined as a chronic musculoskeletal problem that is provoked
by activities that cause loading in the patellofemoral joint (PFJ), describes pain around and behind the
patella, and causes persistent pain in the front of the knee in the absence of other differential pathologies.
There is increased pain during and after activities that loading on the PFJ, such as squatting, prolonged
sitting, and climbing and descending stairs. It is the most common reason for applying to orthopedics
and traumatology, sports medicine, orthopedic and sports rehabilitation clinics with anterior knee pain.
Although its actual incidence has not been adequately studied, PFPS is the most common cause of lower
extremity pain. Despite the limited number of studies investigating its incidence, PFPS is shown as the most
common cause of pain in the lower extremity.Although PFP is thought to affect the whole society, it’s seen
especially in adolescents, young active adults, elite athletes, military staff and women with a high incidence
and prevalence. The current treatment of PFPS focuses on conservative treatment, in which physiotherapy
plays an important role. Physiotherapy is a treatment method that is frequently used to manage dysfunction
in PFPS and to reduce the pain experienced by patients, and it prioritizes exercise approaches to reduce
pain and improve knee function. The main goal of conservative treatment is to bring the patella to an
optimal biomechanical alignment and to strengthen the musculature around the knee. In the treatment,
a combined approach is adopted, often supported by exercise to improve PFJ mechanics, taping, insoles,
biofeedback and other adjuvant treatments. Traditionally, knee-focused exercises focused on strength and
coordination in the quadriceps femoris muscles have been used, while hip-focused exercises have recently
become the focus of attention
The link between total antioxidant status, total oxidant status, arylesterase activity, and subgingival microbiota in psoriasis patients
No full textBackground Studies focusing on the relationship between periodontitis and systemic diseases have suggested a possible association between these two chronic and inflammatory disorders. We aimed to comparatively investigate the salivary oxidative status, biomarker levels, clinical findings, and the microbial load on subgingival biofilm samples in psoriasis patients and controls. Methods Forty participants were allocated into four groups as follows: (1) systemically and periodontally healthy (C group); (2) systemically healthy with periodontitis (P group); (3) psoriasis (Ps) and periodontally healthy (Ps-C group); and (4) Ps with periodontitis (Ps-P group). Subgingival biofilm samples were obtained to detect the periodontopathogenic agents by Real-time PCR (qPCR). The total antioxidant status (TAS) (mmol/l), total oxidant status (TOS) (mu mol/l), and arylesterase (ARE) activity (U/L) were analyzed using saliva samples. Results The level of TOS and oxidative stress index (OSI) were significantly higher in patients with Ps-P and P compared to controls (P = 0.001, and P 0.05). Conclusions This study reported that psoriasis may amplify TOS and OSI, and the co-existence of psoriasis and periodontitis may aggravate oxidative stress
Erkek Üreme Sistemi ve Ateşli Silah Yaralanması: 2 Olgu Sunumu
Get PDFAteşli silah yaralanmaları sonucunda meydana gelen genital yaralanmalar nadir görülür. Nadir görülen bu
yaralanmalar sonucunda birçok ciddi komplikasyon ortaya çıkmaktadır. Hastalar organ kaybı veya organların fonksiyon kaybı gibi istenmeyen sonuçlarla karşılaşmaktadır. Bu yazımızda ateşli silaha bağlı genitoüriner sistemde yaralanma meydana gelen iki olgumuzu değerlendirdik. Olgularımızın birinde orşiektomi
diğerinde ise kord onarımı yapıldı. Bu iki olguyu sunarak literatür eşliğinde tartışmayı amaçladık.Genital injuries are rare resulting from gunshot wounds. As a result of these rare injuries, many serious
complications occur. Patients encounter undesirable results such as organ loss or loss of organ function.
In this article, we evaluated two cases of genitourinary system injuries due to firearms. Orchiectomy was
performed in one of our cases and cord repair was performed in the other. We aimed to discuss these two
cases in the light of literature
Discussing the roles of proline and glycine from the perspective of cold adaptation in lipases and cellulases
Get PDFLipases and cellulases have been extensively used in the field of biotechnology for varied purposes. Mainly, the ongoing researches focus on the improvements of kinetic and enzymatic characteristics of enzymes to meet industrial needs. With the discovery of psychrophilic cellulase and lipase sources, a new era has opened for protein research by allowing the discovery of novel functions together with the description of unique cold adaptation mechanisms to harsh environments. The ability of cold-adapted lipase and cellulases to enable chemical reactions at lower temperatures provides a great opportunity to cut the cost of the finished product by lowering energy and purifying expanses. The advances in the cold-adapted lipase and cellulase enzymes are the cumulative efforts of organic chemists, biophysicists, biotechnologists, and process engineers who greatly contribute to a better understanding of cold-adaptation phenomena from different points of view. In this review, we cover the cold-adaptation aspects of cellulase and lipase enzymes from structural points of view by referring to the roles of Gly and Pro residues. Gly and Pro residues accelerate the cold-adaptation of enzymes by altering the conformational changes in the 3 D structure of proteins The list of microorganisms as a source of cold-adapted cellulases and lipases is given by referring to biotechnological applications. After introducing the thermodynamic background of Gly and Pro residues in the phenomena of cold-adaptation, specific examples are given to emphasise how introducing Gly and Pro into 3 D structure of protein molecules adds value in terms of biotechnological application by contributing to cold-adaptation
Transcutaneous Tibial Nerve Stimulation as Therapy for Functional Constipation
Get PDFBackground: Functional constipation is a common disorder that is difficult to treat on occasion. Symptoms of this condition can persist despite dietary modification, exercise, and medication. Results of neuromodulation with nerve stimulation have been promising in terms of efficiency for treatment-resistant patients. This study aimed to investigate the efficacy of bilateral transcutaneous tibial nerve stimulation as a noninvasive treatment method for functional constipation.
Methods: We evaluated 105 patients with functional constipation diagnosed using the Rome IV criteria. Bilateral transcutaneous electrical nerve stimulation was utilized for transcutaneous tibial nerve stimulation for 6 weeks; 3 sessions were conducted every week, with each session lasting for at least 30 minutes. The Constipation Severity Instrument was used before treatment, at the end of 6 weeks, and at 12 weeks (6 weeks after the end of treatment). The effects of transcutaneous tibial nerve stimulation on the time spent in the toilet and the use of softeners were investigated.
Results: Of the 105 patients included in the study, 41 (39%) were male. The mean age was 43.1 (range, 19-64 years). Transcutaneous tibial nerve stimulation was found to reduce the time patients spent in the toilet. The use of softeners decreased from 76.2% to 20% (P <.001). Obstructive defecation (P <.001), colonic inertia (P <.001), pain (P <.001), and Constipation Severity Instrument total score (P <.001) improved after the 6-week treatment period. The treatment effect persisted until the 12th week.
Conclusion: Bilateral transcutaneous tibial nerve stimulation is a noninvasive, easily applicable, and effective treatment for functional constipation, without major adverse effects. Large randomized controlled trials are required so that transcutaneous tibial nerve stimulation can be established as an alternative treatment for functional constipation that is resistant to standard care and laxative agents
Prescription of knee braces after anterior cruciate ligament reconstruction: Fact or fiction?
Get PDFObjectives: This study aims to compare the clinical results of patients rehabilitated with or without a rehabilitative knee brace (RKB) after
anterior cruciate ligament (ACL) reconstruction.
Patients and methods: This retrospective, comparative study was conducted at between January 2013 and December 2017. A total of
119 patients (112 males, 7 females; mean age: 32.0±8.6 years; range, 18 to 45 years) with acute ACL ruptures treated with arthroscopic
ACL reconstruction and rehabilitated with (n=56) or without RKB (n=63) participated in the study. The minimum follow-up time was
24 months. The ACL quality of life (QoL) questionnaire, Lysholm Knee Scoring Scale, and Tegner Activity Level Scale were used for the
evaluation of the QoL, knee function, and activity level, respectively. The time to return to sports was recorded. The side-to-side difference
in the anterior translation of the tibia was measured using a KT-1000 arthrometer.
Results: The mean follow-up time was 38.4±9.1 (range, 24 to 56) months. Baseline demographics and clinical characteristics were similar
between groups. Regarding QoL, knee function, and activity level, no significant difference was observed between patients who used RKB
and those who did not use it at the postoperative 12th month (p=0.95, p=0.56, p=0.98, respectively) and the latest follow-up (p=0.21, p=0.73,
p=0.99, respectively). The mean time to return to sports (nearly 11 months for both groups) and side-to-side difference in the anterior tibial
translation at the latest follow-up was also similar between groups (p=0.15 and p=0.15, respectively). There was no graft rupture during
the follow-up in both groups. The complication rates were 7.9% and 7.1% for no brace and brace groups, respectively, without a statistically
significant difference (p=0.87).
Conclusion: According to the results of this study, there was no significant difference between the rehabilitative brace and no brace groups
in clinical outcomes after ACL reconstruction
Significance of Cyclooxgenase-2 gene polymorphism and related miRNAs in pulmonary arterial hypertension
Get PDFBackground: Pulmonary arterial hypertension (PAH) is a rare disease with a poor prognosis. The suppression of cyclooxygenase-2 (COX-2) expression has been known to impair vascular function in endothelial cells; however, the epigenetic factors that cause this are largely obscure. Our aim in this study was to examine the polymorphisms in the gene for COX-2 (PTGS2) and related miRNAs regulating its level in a single-center cohort of patients with PAH. Method: In this study, three SNPs and miRNAs (rs5275, rs689470, rs20417, miR-26b-5p, miR-146a-5p, and miR101-5p) in the PTGS2 were screened in PAH and controls by qPCR. In addition, the COX-2 level was determined by immunoassay to examine the effects of epigenetic factors on its expression levels. Results: The non-dominant genotypes of rs20417 and rs5275 were found to be related to PAH (OR = 8.56, 95% CI = 3.39–21.63, p < 0.0001 and OR = 7.82, 95% CI = 3.30–18.53, p < 0.0001, respectively). We also observed a significant increase in the miR-26b-5p and miR-146a-5p levels in PAH patients (2.18 and 2.35-fold, respectively; for both, p < 0.05). In addition, it was found that SNPs influenced the COX-2, miR-26b-5p, and miR-146a5p levels in PAH. A negative correlation was also found between COX-2 levels and miR-26b-5p and miR-146a-5p. Conclusions: As conventional drug therapies may cause lower COX-2 levels, the development of new genetic or epigenetic biomarkers is crucially important for early diagnosis and prognosis. The presence of minor alleles for rs5275 and rs689470 might also be considered as a significant risk factor for developing PAH. Furthermore, locus-specific miRNAs, such as miR-26b-5p and miR-146a-5p, seem to play a critical role in the regulation of PTGS2 expression
Relationship between inter-recti distance, abdominal muscle endurance, pelvic floor functions, respiratory muscle strength, and postural control in women with diastasis recti abdominis
Get PDFObjective: The main objective was to assess the relationship between inter-recti distance (IRD) and abdominal
muscle endurance, pelvic floor functions, respiratory muscle strength, and postural control in women with
Diastasis Recti Abdominis (DRA). Additionally, the secondary purpose of the study is to investigate the independent predictors of IRD in women with DRA.
Study design: Fifty-one women who were diagnosed with DRA participated to the study. IRD assessment with a
caliper, abdominal muscle endurance test, Pelvic Floor Distress Inventory Questionnaire-20 (PFDI-20), maximum
inspiratory and expiratory pressure (MIP and MEP, respectively) tests, Clinical Test of Sensory Integration of
Balance (m-CTSIB) under eyes open on a firm surface (EOFS), eyes closed on a firm surface (ECFS), eyes open on
a foam surface (EOFoS), and eyes closed on a foam surface (ECFoS) conditions, and Limits of Stability (LOS) tests
were performed for all subjects. Pearson or Spearman correlation analyses were used to determine the relationship between IRD and static abdominal flexion endurance test, PFDI-20, MIP and MEP, m-CTSIB, and LOS
scores depending on the distribution properties of the data. Additionally, linear regression analysis was utilized
for analyzing the independent predictors of IRD among the age, BMI, parity, time since last birth, birth weight,
weight gains last pregnancy, and mode of delivery.
Results: IRD had correlations with Colorectal–Anal Distress score of PFDI-20 (r = -0.317, p = 0.03) and EOFS,
ECFS, EOFoS, ECFoS and composite score of m-CTSIB (r = 0.356, p = 0.01; r = 0.337, p = 0.02, r = 0.279, p =
0.04; r = 0.265, p = 0.04; r = 0.413, p = 0.004, respectively) and LOS scores (r = 0.422, p = 0.003). Increased
IRD did not influence abdominal muscle endurance and respiratory muscle strength in women with DRA (p <
0.05). Age, BMI, time since last birth, weight gains last pregnancy, and mode of delivery were not determined as
the factors that influence IRD in women with DRA (p < 0.05).
Conclusion: We concluded that increased IRD is associated with worse postural control, but better colorectal
functions in women with DRA. Additionally, IRD does not show a clear association with abdominal muscle
endurance, pelvic floor functions, and respiratory muscle strength. According to our results, postural stability
assessments may perform in the physiotherapeutic management of women with DRA
Accessibility to dental services by immigrant and refugee children residing in Turkey
Get PDFBackground: Turkey is hosting the world's largest immigrant population under temporary and international protection. Due to the social inequalities contributing to early childhood dental caries, the effectiveness of dental care service for immigrant children should be evaluated. Aim: To evaluate the accessibility of immigrant and refugee children residing in four different regions of Turkey to oral health products and dental treatment services. Design: A questionnaire consisting of 21 questions was administered: The first six questions elicited demographic data, and the remaining 15 questions asked about oral health habits, access to oral hygiene materials, and dental treatment services. Participants included the parents of 430 children under the age of 18, who were registered with migrant associations in the regions where they lived (Istanbul, Samsun, Hatay, or Ankara). Results: The majority of the participants were from Syria and Iraq. Of the participants, 42.1% reported that their children's oral hygiene habits had changed negatively after they migrated, 71.9% reported that they had not been to the dentist in the last year, and 82.8% reported that they had not been to the dentist for more than 12months. Access to oral and dental hygiene products was not difficult for 68.4%. About 62.6%, however, reported that they had difficulty accessing dental treatment. Conclusion: The findings showed that this disadvantaged group had difficulty accessing dental treatment. Therefore, there is a need for national and international health strategies to ensure that immigrant and refugee children have effective access to dental treatment
Open double-button technique is superior to hook plate in the treatment of acute Rockwood Type III/V acromioclavicular dislocations
Get PDFBACKGROUND: The aim of this study is to compare open double-button (DB) and hook plate (HP) techniques in the treatment of acromioclavicular joint dislocation (ACJD) in terms of clinical and radiological outcomes and to determine which method is superior. METHODS: This retrospective comparative study included patients with ACJDs (Rockwood Type III/V) who were treated with one of these implants (22 patients with HP, 21 patients with DB) between June 2014 and February 2018. RESULTS: A total of 43 patients (39 men and 4 women) with a mean age of 41.8??17.4 years have participated in this study. The mean follow-up time was 20.6??7.5 months. Mean times of fluoroscopy, operation, and return to work were shorter in the DB group. Complication rates were 23.8% and 54.6%, reoperation rates (including mandatory implant removals [IR]) were 4.8% and 77.3%, mean constant scores were 92.1??3.4 and 88.3??4.2, and mean Visual Analog Scale scores were 0.8??1.0 and 1.5??1.0 for the DB and HP groups, respectively. IR was the main reason for reoperations in the HP group, whereas the DB group???s only reoperation was caused by a coracoid cutout (due to coracoid tunnel malposition) leading to redislocation. AC joint arthritis (36.4%) and subacromial osteolysis (31.9%) were commonly encountered in the HP group. The most frequent complication of the DB group was malreduction (initial undercorrection) (9.6%). CONCLUSION: DB was superior to HP in functional outcome, post-operative pain, complication and reoperation rates, operation and fluoroscopy times, and time to return to work. Besides, reoperation (for IR) was needed in most of the HP patients. Therefore, the open DB technique should be preferential to the HP procedure