Athletes and superstitious rituals.

Superstitious rituals are common in sports and can play a role in athletes' optimism, sense of control, and confidence in performance. Superstitious rituals have characteristics rooted in tradition and need for perfection. While superstitious rituals vary in type of activity, it is necessary to consider their impact on players and the team, and to guide athletes into positive forms of expression to optimize their performance and overall well-being when engaged in their athletic activities. This paper explores the potential benefits and challenges of superstitious rituals, and the ways in which positive alternative pathways can contribute to peak performance in athletes.

Patient Discomfort and Resident Confidence After Knee Intra-articular Injection Simulation Training: A Randomized Control Trial Study.

Teaching primary care providers how to perform musculoskeletal procedures has become increasingly important as more and more patients with orthopedic conditions present in primary care clinics. This study aims to evaluate whether targeted simulation model training in residency can increase residents' comfort level in performing intra-articular knee injections and decrease the pain of the procedure, as reported by patients injected. Residents were randomized into intervention and control groups. The comfort level of the residents as well as the pain levels from the procedures, as reported by patients, was recorded. The mean comfort level for the intervention group was 1.2, compared with that in the control group, which was 2.13; P value was .047. The mean pain level in the intervention group was 1.8, whereas in the control group was 3.63; P value was .156. Simulation training may boost residents' comfort level, but not necessarily decrease patient discomfort during intra-articular knee injections.

Body Mass Index as a Predictor of Injuries in Athletics.

The quest to identify injury risk factors in sports has been an ongoing and well-researched field in the world of sports medicine. Knowing some of these factors helps keep sports participation safe. Both intrinsic and extrinsic factors have been studied. Body mass index (BMI) is widely known to contribute to several medical conditions. Its association with some sports injuries has been established but the information is vast, with few studies that are randomized controlled trials. It is important to analyze these studies and confirm whether BMI is a predictor of lower-extremity injuries. Such knowledge allows for better effective treatment and prevention strategies. This article will summarize current evidence of association between BMI and lower-extremity injuries in athletes and whether BMI is a predictor of lower-extremity injuries.

Ultrasound-Diagnosed Tibia Stress Fracture: A Case Report.

Stress fractures are a frequent cause of lower extremity pain in athletes, and especially in runners. Plain imaging has a low sensitivity. Magnetic resonance imaging (MRI) or bone scan scintigraphy is the criterion standard, but expensive. We present the case of a young female distance runner with left shin pain. Plain radiography was unremarkable. Ultrasound showed focal hyperechoic elevation of the periosteum with irregularity over the distal tibia and increased flow on Doppler. These findings were consistent with a distal tibia stress fracture and confirmed by MRI. Examination of our case will highlight the utility of considering an ultrasound for diagnosis of tibial stress fracture.

Correlation of Bone Mineral Density Scores and Proton Pump Inhibitors Use in the Elderly.

OBJECTIVE: We aimed to identify any correlation between long-term proton pump inhibitor use and low bone mineral density in the elderly. MATERIALS AND METHODS: This is a retrospective cohort study looking at PPI usage and bone mineral density scores of patients age 65 and above within a period of two years. Lumbar spine, right hip, and left hip bone mineral density t-scores were reviewed in PPI users and non-users. RESULTS: A total of 1,016 patients who had bone mineral density scans within that period were identified. Non-adjusted data showed no statistically significant association between PPI users and non-users in lumbar spine (p = 0.903), right hip (p = 0.775) and left hip (p = 0.407) bone mineral density scores. After adjusting for age and gender, PPI use was still not associated with low bone mineral density at the lumbar spine (p = 0.957), right hip (p = 0.440), or left hip (p = 0.691). Thelogistic regression did not show a statistically significant difference in low bone mineral density scores in lumbar spine (p= 0.162), right hip (p = 0.796), and left hip (p = 0.196) when length of use was considered. CONCLUSION: Among adults 65 years and older proton pump inhibitors users; there appears to be no correlation betweenPPI use and low bone mineral density and/or the length of PPI use.

Correlation of Bone Mineral Density Scores and Proton Pump Inhibitors Use in the Elderly.

OBJECTIVE: We aimed to identify any correlation between long-term proton pump inhibitor use and low bone mineral density in the elderly. MATERIALS AND METHODS: This is a retrospective cohort study looking at PPI usage and bone mineral density scores of patients age 65 and above within a period of two years. Lumbar spine, right hip, and left hip bone mineral density t-scores were reviewed in PPI users and non-users. RESULTS: A total of 1,016 patients who had bone mineral density scans within that period were identified. Non-adjusted data showed no statistically significant association between PPI users and non-users in lumbar spine (p = 0.903), right hip (p = 0.775) and left hip (p = 0.407) bone mineral density scores. After adjusting for age and gender, PPI use was still not associated with low bone mineral density at the lumbar spine (p = 0.957), right hip (p = 0.440), or left hip (p = 0.691). The logistic regression did not show a statistically significant difference in low bone mineral density scores in lumbar spine (p = 0.162), right hip (p = 0.796), and left hip (p = 0.196) when length of use was considered. CONCLUSION: Among adults 65 years and older proton pump inhibitors users; there appears to be no correlation between PPI use and low bone mineral density and/or the length of PPI use.

Syndrome of inappropriate antidiuretic hormone secretion: a story of duloxetine-induced hyponatraemia.

Hyponatraemia is the most commonly encountered electrolyte abnormality in clinical practice. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) accounts for nearly 60% of all hyponatraemias. Selective serotonin reuptake inhibitors (SSRIs) are well known to have side effects of SIADH. There have been few reported cases of serotonin norepinephrine reuptake inhibitors (SNRIs) causing SIADH-induced hyponatraemia. Duloxetine is one type of SNRI used to treat several conditions, including depression and diabetic neuropathy. We present a case of a 76-year-old woman with a history of fibromyalgia who had recently been prescribed duloxetine for her condition. On admission to the hospital, her sodium decreased to a low of 118 mmol/L. Evaluation for other causes of hyponatraemia yielded negative results. Duloxetine was discontinued and after 3 days the patient's sodium increased to 130 mmol/L. The purpose of this case report is to highlight the importance of having suspicion for rare but real side effects of medications such as duloxetine.

Family medicine residents' perceived level of comfort in treating common sports injuries across residency programs in the United States.

BACKGROUND AND OBJECTIVE: Family physicians are expected to be comfortable in treating common sports injuries. Evidence shows a limited level of comfort in treating these injuries in pediatric and internal medicine residents. Studies are lacking, however, in family medicine residents. The purpose of this study is to assess the comfort level of family medicine residents in treating common sports injuries in adults and children based on their perceived level of knowledge and attitudes. METHODS: This is a cross-sectional study of family medicine residents in the United Sates. A written survey of 25 questions related to sports injury knowledge and factors affecting comfort level were collected. A chi-square test was implemented in calculating P-values. RESULTS: Five hundred and fifty-seven residents responded to the survey. A higher percentage of doctors of osteopathy (86.6%, 82.5%, 69.6%, and 68.7%) compared to doctors of medicine (78.5%, 71.6%, 53.4%, and 52.8%) respectively identified ankle sprain, concussion, plantar fasciitis, and lateral epicondylitis as common injuries, and felt comfortable in treating them (P-values =0.015, 0.004, 0.0001, and 0.0002, respectively). Residents with high interest in sports medicine correctly identified the injuries as common and felt comfortable treating them as well (knowledge, P=0.027, 0.0029, <0.0001, and 0.0001, respectively; comfort level, P=0.0016, <0.0001, 0.0897, and 0.0010, respectively). CONCLUSION: Medical education background, factors that affect training, and an interest in sports medicine contribute to residents' knowledge and comfort level in treatment of common sports injuries.

Osteoarthritis in young, active, and athletic individuals.

Osteoarthritis (OA) is one of the most devastating chronic conditions that affect people around the world. Although the usual population associated with the condition is the elderly, who are mostly inactive, athletes and younger individuals are also susceptible. Depending on the population, the etiology may differ; injuries, occupational activities, and obesity appear to be the most common causes of OA in young and athletic populations. Diagnosing OA in athletes and young individuals is sometimes challenging because of their increased pain tolerance. However, the treatment of OA in these populations does not differ from its management in the general population. Several considerations need to be taken into account when choosing a treatment modality. The purpose of this review is to address OA in athletes and younger individuals and to discuss its presentation, diagnosis, and treatment.