PRESENTATION OF CASE: 1st case: A-39-years-old male, complain of irreducible right patella dislocation with valgus knee and already done soft tissue procedure for patella dislocation. Long-leg radiographs of the right leg showed 18° valgus mechanical angle. 2nd case: A-26-years-old obese female, complain of dislocation of left patella and history of surgery for dislocation at 5 years old. Long-leg radiographs of the right leg showed 11° valgus mechanical angle.
DISCUSSION: After knowing the cause of the patellar dislocation from history taking, physical and supporting examination, we performed lateral open wedge distal femoral osteotomy also MPFL and MCL reconstruction, and tibial tuberosity medialization osteotomy. There is improvement mean score in Tegner Lysholm Knee Scoring system and IKDC Scoring at 6 months after surgery.
CONCLUSION: Lateral open wedge distal femur osteotomy combine with MPFL and MCL reconstruction and tibial tuberosity medialization realignment procedure can be successfully done for improve irreducible patellar dislocation in valgus knee, from clinical and radiological evaluation have good outcome after surgery.
DESIGN AND METHODS: A survey method was used in this research with a descriptive analysis, Antimicrobial activity testing was done with bacteria Escherichia coli O157, Staphylococcus aureus, Listeria monocytogenes, and Listeria innocua. Molecular identification was done using the 16S rRNA gene.
RESULTS: Probiotic candidate test with the best results in testing for resistance to stomach acid at pH3 with the viability of 65.98%, bile salt resistance 0.3%, viability of 54.90% from 2DA isolates. Antimicrobial activity with the best clear zone area results was obtained in 2DA isolates with Escherichia coli O157 test bacteria of 21.16 mm, Staphylococcus aureus with a clear zone area of 23.17 mm, Listeria innocua of 19.24 mm and Listeria monocytogenes with a clear zone area 18.23 mm in 4DA isolate, LAB identification using 16S sRNA gene, results of running PCR base length 1419bp.
CONCLUSIONS: Phylogenetic analysis shows that Dadiah of Limapuluh Kota Regency is a kin to Lactobacillus plantarum. The superiority of identification technology by using 16S rRNA gene only can be conducted if the nucleotide sequence information of the targeted bacteria is known beforehand.
METHODS: Following a thematic literature review and pre-meeting survey, a SEA expert panel comprising 13 psychiatrists with clinical experience in managing patients with TRD convened and utilized the RAND/UCLA Appropriateness Method to develop consensus-based recommendations on the appropriate definition of TRD and principles for its management.
RESULTS: The expert panel agreed that "pharmacotherapy-resistant depression" (PRD) is a more suitable term for TRD and defined it as "failure of two drug treatments of adequate doses, for 4-8 weeks duration with adequate adherence, during a major depressive episode". A stepwise treatment approach should be employed for the management of PRD - treatment strategies can include maximizing dose, switching to a different class, and augmenting or combining treatments. Non-pharmacological treatments, such as electroconvulsive therapy and repetitive transcranial magnetic stimulation, are also appropriate options for patients with PRD.
CONCLUSION: These consensus recommendations on the operational definition of PRD and treatment principles for its management can be adapted to local contexts in the SEA countries but should not replace clinical judgement. Individual circumstances and benefit-risk balance should be carefully considered while determining the most appropriate treatment option for patients with PRD.