Comparison of the application of intra-articular and intravenous tranexamic acid to reduce blood loss during primary total knee arthroplasty

Tranexamic acid (TXA) is frequently administered intravenously because it is recognized as a safe and effective procedure. This study's objective is to evaluate the effectiveness of intravenous and intra-articular TXA treatments in patients who have had primary unilateral knee joint replacement. Patients were divided into groups based on TXA applications. Group A patients, those who received intravenous TXA, Group B patients, those who received intraarticular TXA, and Group C patients were intended to serve as the control group. Age, gender, ASA scores, length of hospital stay, preoperative, postoperative, and discharge hemoglobin and hematocrit levels, and the quantity of blood product transfusion given to the patients was analyzed retrospectively. Analysis of the patient’s postoperative Hb values revealed that group C patients had lower Hb values (p < 0.05). Postoperative Hct levels were also seen to be significantly lower in group C individuals (p < 0.05). When the patients' Hb levels were measured at discharge, it was discovered that group C patients had lower Hb levels (p < 0.05). The Hct values of group C patients at discharge were also found to be considerably lower (p < 0.05). It was found that group C patients received significantly more blood transfusions than the other groups (p < 0.05) when the number of patient blood transfusions was compared between the groups. Intravenous and intra-articular TXA successfully minimize blood loss in primary TKA. The benefits of intra-articular administration over intravenous administration include convenience of administration, local application, and a higher level of safety

Pre- and Post-Operative Hamstring Autograft ACL Reconstruction Isokinetic Knee Strength Assessments of Recreational Athletes

Background and Objectives: Anterior cruciate ligament (ACL) injuries are common injuries with a high incidence among people with high physical activity levels. Therefore, ACL reconstruction (ACLR) is one of the most common surgical procedures performed in sports medicine. This study aims to compare the pre- and 6-month post-operative isokinetic knee strengths in healthy (HK) and ACL knees of patients who underwent semitendinous/gracilis (ST/G) ACLR. Materials and Methods: A retrospective cohort of 21 recreational athletes who underwent ST/G ACLR by the same surgeon were evaluated. The pre- and 6-month post-operative isokinetic knee extension (Ex) and flexion (Flx) strengths of the HK and ACLR patients were evaluated in a series consisting of three different angular velocities (60, 180 and 240°/s). Of all the findings, peak torque (PT) and hamstring/quadriceps (H/Q) parameters were evaluated. Results: There was a significant improvement in post-operative Lysholm, Tegner and IKDC scores compared to pre-operative scores (p p p > 0.05). As for H/Q ratios, there was a significant difference between pre- and post-operative values only at 60°/s angular velocity in both ACLR and HC (p < 0.005). Conclusions: The pre-operative and 6-month post-operative results of the ST/G ACLR showed that there was a high level of recovery, particularly in quadriceps strength, while the increase in strength was less in the hamstring. The significance observed at 60°/s in H/Q ratios was within normal ranges. It can be argued that the ST/G ACLR method is feasible for people with high physical activity levels and for athletes

Covid-19 related anxiety levels of emergency service personnel: A cross-sectional studyfrom Turkey

COVID-19 pandemic significantly affects the mental health of the personnel working in the frontline of the healthcare system. The present study aimed to determine theprevalence of anxiety and risk factors in people who served in the emergency health system during the COVID-19 pandemic. The study was designed as a cross-sectionalonline survey conducted on healthcare staff working in emergency services throughout the country between May 15 and June 15, 2020. The questionnaire form consistedof two parts. The first part included sociodemographic questions (13 questions), while the second part consisted of 20 questions found in STAI (State-Trait AnxietyInventory) anxiety. Multivariate logistic regression analysis was performed to identify the potential risk factors for anxiety symptoms in the participants. Relationshipsbetween risk factors and their consequences were stated as rates (ORs) and 95% CI. A total 1014 completed the survey. Among the respondents, 54.3% male, 41.3%18–29 age group, 60.4% married, 44.9% doctors, and 63.4% working in the city center. Analysis showed that anxiety triggering factors included being a female (OR, 1.50;95% CI, 1.13–1.99; p = 0.004), working as an emergency medical technician (OR, 7.42; 95% CI, 1.09–50.53; p = 0.041), large family (OR, 1.69; 95% CI, 1.06–2.70; p= 0.041), few children (OR, 1.28; 95% CI, 0.84–2.15; p = 0.068), and working in the town center (OR, 1.43; 95% CI, 1.06–1.93; p = 0.017). Our results showed that theanxiety level is high for a significant portion of the emergency staff during the pandemic and that risk-enhancing factors exist in their home and work lives during thisperiod. It is important to carry out supportive administrative studies aimed at reducing stress and anxiety levels, especially for the health staff working in the frontlineduring the pandemic

Evaluation of Postoperative Analgesic Efficacy of Ultrasound-Guided Suprainguinal Fascia Iliaca Block in Knee Arthroplasty: Prospective, Randomized, Feasibility Study

Background: Total Knee Arthroplasty (TKA) is one of the most commonly performed orthopedic procedures, and patients complain of severe pain in the postoperative period. The supra-inguinal fascia iliaca block (SIFIB) works as an anteriorly applied lumbar plexus block and is frequently used in hip surgeries. In this study, we evaluated the effect of SIFIB in patients undergoing TKA under spinal anesthesia. Methods: This study is a prospective, randomized, assessor-blinded feasibility study conducted in a tertiary hospital. Eighty-six patients with ASA I-III were initially enrolled, and after exclusions, 80 patients were randomized into two equal groups (SIFIB and control groups). The standard multimodal analgesia was applied to the control group, while SIFIB was additionally applied to the block group. The study measured the morphine requirement in PCA and pain intensity using Numeric Rating Scores between the two groups. Results: the 24-h cumulative morphine consumption was lower in Group SIFIB. Although there was a decrease in NRS at rest scores in the SIFIB group during some time periods, pain was moderate, and no differences in pain scores were recorded during exercise in all patients. Conclusions: In patients undergoing TKA under spinal anesthesia, a single shot of SIFIB results in a significant reduction in the amount of morphine consumed in hours. This effect was most likely related to a decrease in pain at rest in the SIFIF group

Post-Operative Modified All-Inside ACL Reconstruction Technique’s Clinical Outcomes and Isokinetic Strength Assessments

Background and Objective: Anterior cruciate ligament (ACL) injuries are very common among the athletic population. ACL reconstruction (ACLR) performed because of these injuries is one of the procedures performed by orthopedic surgeons using different grafting methods. This study aims to compare the data related to post-operative 6-month isokinetic strength values, strength-related asymmetry rates, time parameters, and joint angle in athletes who underwent ACLR with the Modified All-inside (4ST) technique, on both the healthy knee (HK) and the ACLR-applied sides. Materials and Methods: A total of 20 athletes from various sports on whom the 4ST ACLR technique had been applied by the same surgeon were evaluated retrospectively. Lysholm, Tegner, and International Knee Documentation Committee (IKDC) scores of the patients were obtained pre-operative and at 6 months post-operative. Isokinetic knee extension (Ex) and flexion (Flx) strengths on the HK and ACLR sides of the patients were evaluated with a series of four different angular velocities (60, 180, 240, and 300°/s). In addition to peak torque (PT) and hamstring/quadriceps ratio (H/Q) parameters, the findings were also evaluated with additional parameters such as joint angle at peak torque (JAPT), time to peak torque (TPT), reciprocal delay (RD), and endurance ratio (ER). Results: There was a significant improvement in the mean Lysholm, Tegner, and IKDC scores after surgery compared with pre-operative levels (p < 0.05). As for PT values, there were significant differences in favor of the HK in the 60, 180, and 300°/s Ex phases (p < 0.05). In terms of the H/Q and (hamstring/hamstring)/(quadriceps/quadriceps) (HH/QQ) ratios, there were significant differences at 300°/s (p < 0.05). In terms of JAPT, there were significant differences in the 300°/s Ex and 180°/s Flx phases (p < 0.05). In terms of TPT, there were significant differences in the 300°/s Ex phase (p < 0.05). In terms of RD and ER, no significant difference was observed between the HK and ACLR sides at any angular velocity. Conclusions: Although differences were observed in PT values, particularly in the Ex phase, this did not cause a significant change in H/Q ratios. Similar results were observed for additional parameters such as JAPT, TPT, RD, and ER. The results show that this ACLR technique can be used in athletes in view of strength gain and a return to sports