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Background Core stabilization exercises are a crucial intervention in Adolescent Idiopathic Scoliosis (AIS), as they are widely accessible and specifically address trunk muscle weakness and neuromuscular deficits that are considered potential contributors to curve progression. The aim of this study was to demonstrate the effects of core stabilization based exercise training on muscle strength, neuromuscular control, quality of life, and Cobb angle improvement in patients with AIS. Methods Thirty two patients with AIS were included in this prospective, randomized, and controlled study. Participants were randomly divided into two groups as training group ( n  = 16) and control group ( n  = 16). Two individuals were lost to follow-up, resulting in a final analytical sample of 30 participants, with 15 in the training group and 15 in the control group. Training group received core stabilization based exercise training. Control group received traditional exercises. These interventions were carried out in 16 sessions under the supervision of a physiotherapist 2 days a week to be applied daily for 8 weeks. Muscle strength (Biodex isokinetic dynamometer), neuromuscular control (sEMG), Cobb angle, quality of life (SRS-22 questionnaire), perception of cosmetic deformity (WRVAS), trunk rotation angle, and spinal flexibility were assessed at the beginning and end of the study. Between-group comparisons were performed using analysis of covariance (ANCOVA) with baseline values as covariates, and statistical significance was set at p  < 0.05. Results Compared with the control group, the training group demonstrated significantly greater improvements in trunk muscle strength and neuromuscular control, with significant changes observed in the majority of parameters ( p  < 0.05). A clinically meaningful reduction in Cobb angle was observed in the training group (mean decrease: 5.7°, p  < 0.001). Significant between-group improvements were also found in trunk rotation angle, spinal flexibility, quality of life, and perception of cosmetic deformity ( p  < 0.05). Conclusions Based on comprehensive and objective assessments, and after adjusting for baseline differences, these findings indicate that core stabilization based exercise training may provide meaningful benefits for patients with AIS and support its consideration as a complementary component of conservative management.

Background Currently, there is no comprehensive and multidisciplinary recommendation study covering all aspects of pediatric dysphagia (PD). This study aimed to generate PD management recommendations with methods that can be used in clinical practice to fill this gap in our country and in the world, from the perspective of experienced multidisciplinary experts. Methods This recommendation paper was generated by a multidisciplinary team, using the seven-step process and a three-round modified Delphi survey via e-mail. First, ten open-ended questions were created, and then detailed recommendations including management, diagnosis, treatment, and follow-up were created with the answers from these questions. Each recommendation item was voted on by the experts as overall consensus (strong recommendation), approaching consensus (weak recommendation) and divergent consensus (not recommended). Results In the 1st Delphi round, a questionnaire of 414 items was prepared based on the experts’ responses to ten open-ended questions. In the 2nd Delphi round, 59.2% of these items were accepted as pre-recommendation. In the 3rd Delphi round, 62.6% of 246 items were accepted for inclusion in the proposals. The final version recommendations consisted of 154 items. Conclusions This study includes comprehensive and detailed answers for every problem that could be posed in clinical practice for the management of PD, and recommendations are for all pediatric patients with both oropharyngeal and esophageal dysphagia.

Background Patients increasingly seek online medical information, with artificial intelligence (AI) chatbots like ChatGPT emerging as potential resources for adolescent idiopathic scoliosis (AIS); however, their accuracy and reliability need assessment. This study aimed to evaluate the accuracy and reliability of ChatGPT, an AI model, in answering questions related to AIS. Methods Sixty-four questions across four categories (general information, diagnosis and screening, treatment and follow-up, and quality of life [QoL]) were adapted from FAQs on professional association websites, the SOSORT consensus article, and QoL questionnaires. Two reviewers rated ChatGPT’s responses on a scale from 1 (correct and comprehensive) to 4 (completely incorrect). Descriptive statistics were calculated to demonstrate the percentages of responses per score as well as the percentages of scores across categories. Each question was entered twice to assess reliability and response similarity. The percentage of responses that differed when the same query was entered twice into the system was calculated. The Cohen’s Kappa statistic was utilized to assess the level of agreement between the two reviewers. Results Of all the responses, 53.1% were rated as “correct and comprehensive,” while 34.4% were rated as “correct but not comprehensive.” ChatGPT performed best in the QoL category, with 13 out of 15 (86.7%) responses rated as correct. The second-best performance was in the diagnosis and screening category, with 7 out of 13 (53.8%) correct responses, followed by the general information category, with 9 out of 17 (52.9%) correct responses. The lowest performance was in the treatment and follow-up category, with 5 out of 19 (26.3%) correct responses. Consistency in ChatGPT’s responses when questions were entered twice was 76.6%. Agreement between the reviewers’ scores was excellent, as indicated by Cohen’s Kappa statistic (Kappa: 0.82, 95% CI: 0.59 to 1.04; p  = 0.0001). Conclusions ChatGPT demonstrated strong accuracy in addressing questions related to QoL in AIS, but its accuracy in treatment-related areas remains insufficient. Therefore, patients and parents are advised to consult medical professionals rather than rely solely on AI-generated information for AIS treatment and management.

Objective: Among the hypomyelinating diseases of childhood, Pelizaeus Merzbacher disease (PMD) is caused by X-linked proteolipid protein (PLP) gene mutations, whereas patients without mutations of PLP gene-called Pelizaues Merzbacher-like disease (PMLD) have recessive gap junction protein α12 (gap junction alpha-12/gap junction gamma-2) gene mutations. The aim of this study was to evaluate clinical severity and progression in time in patients with PMD and PMLD. Methods: The motor developmental stages of the patients were reviewed; disease severity was classified according to the walking ability they were able to achieve. Progression pattern was determined according to comparison of neurological findings at the time of the study and at follow-up visits. Patients with PMD and PMLD were compared in terms of disease severity and progression rates as well as patient groups with a unique causative mutation were analyzed individually. Results: There were 9 patients with PMD (mean age 15.2±3.1) and 11 patients with PMLD (mean age 12.4±1.9). The presence of severe disease was more common in patients with PMD when compared to PMLD. In X-linked PMD, missense mutations were associated with the most severe disease and rapid progression, while deletion mutations were associated with mild disease severity and slow progression. Disease severity and progression patterns seemed to be heterogenous in different causative mutations of PMLD. Conclusion: Although PMLD might have milder disease phenotype when compared to PMD, certain causative mutations in different genetic traits may cause different disease severity and progression patterns.

Objective: To compare, in patients with ankylosing spondylitis (AS), the effectiveness on pain, functional and psychological status of an intensive group exercise programme under the supervision of a physiotherapist and a home physiotherapy programme. Design: Fifty-one patients with AS were randomly allocated into study and control groups. The study was designed as a prospective, double-blind study. Setting: Outpatient department, Istanbul Medical Faculty. Subjects: Patients who consulted with complaints of pain, morning stiffness and restricted range of movement with a confirmed diagnosis of ankylosing spondylitis. Interventions: Before exercise, both groups were given an education programme about AS. For group I patients an intensive exercise programme was organized under the supervision of a physiotherapist for six weeks. Group II patients had to practise exercises individually at home. Main outcome measures: Both groups were evaluated and compared for pain, functional and psychological status before treatment, at the end of treatment and three months after treatment using a visual analogue scale (VAS) for pain, Beck Depression Scale and Bath Ankylosing Spondylitis Functional Index (BASFI). Results: Six patients withdrew, four from group I. Results from the remaining 45 showed more positive changes in the patients undertaking group exercise at six weeks and three months after treatment. Values showed a statistical significant difference in favour of group I. Conclusion: Group exercise in hospital may be more effective than home-based exercises at reducing impairment associated with ankylosing spondylitis.

Amaç: Bu çalışmada, immünosüpresif tedavi veren tüm hekimlerin hepatit B virusu (HBV) reaktivasyonuyla ilgili farkındalığının ve bilgi düzeyinin değerlendirilmesi; bu değerlendirme aracılığıyla da konunun önemine dikkat çekilmesi amaçlanmıştır. Yöntemler: Çalışma Ocak-Mart 2017 tarihleri arasında, Türkiye'de 37 sağlık kuruluşunda infeksiyon hastalıkları ve klinik mikrobiyoloji uzmanı hekimler tarafından yürütüldü. Çalışmaya her merkezde Tıbbi Onkoloji, Hematoloji, Deri ve Zührevi Hastalıklar, Fiziksel Tıp ve Rehabilitasyon ve Romatoloji birimlerinde görev yapan ve yazılı onamı alınan tüm uzman hekimler dahil edildi. Bulgular: Araştırmaya toplam 430 hekim katıldı. Hekimlerin yaş ortalaması 39.87±7.42 olup %47.9’unu erkekler oluşturuyordu. Hekimlerin çalışma yılı ortalaması 9.26±7.56 yıldı. Ankete katılan hekimlerin %39.3’ü çalıştıkları süre boyunca immünosüpresif tedavi alırken HBV reaktivasyonu gelişen hastayla karşılaşmışlardı. HBV reaktivasyonu sonucu ölüm gelişen hastayla karşılaşma oranı %6.5 idi. Ankete katılan hekimlerin %97’si HBV reaktivasyonu riskini önemli görmekteydi. Hekimlerin %70.2’si uzmanlık alanıyla ilgili katıldıkları kongrelerde HBV reaktivasyonuyla ilgili rehberlerin ve bu hastalarda antiviral tedavinin tartışıldığını belirtti. HBV reaktivasyonu gelişen hastaları olan hekimlerin hepatit taraması yapma oranı, HBV reaktivasyonu gelişen hastası olmayan hekimlerden istatistiksel olarak anlamlı bir biçimde yüksekti (p<0.05). HBV reaktivasyonuyla ilgili uzmanlık alanına ait rehberleri kullanan hekimlerin bu rehberleri kullanmayan hekimlere göre HBV infeksiyonu yönünden daha fazla tarama yaptığı görüldü (p=0.002). Sonuçlar: Çalışmamızda elde edilen sonuçlara göre, immünosüpresif tedavi veren hekimlerin HBV infeksiyonu yönünden tarama yapma oranları ve farkındalıkları benzer çalışmalara göre daha yüksektir. Bununla birlikte HBV infeksiyonu yönünden taramada kullandıkları serolojik göstergeler arasında HBV DNA ve anti-HBc’nin araştırılmasına daha fazla yer vermeleri için farkındalıklarının artırılması gerekmektedir. Klimik Dergisi 2019; 32(2): 146-53.