Efficacy of ultrasonography in diagnosis of temporomandibular joint soft tissue injury induced by mandibular fractures: randomized clinical trial / Eficácia da ultrassonografia no diagnóstico de lesões em tecidos moles da articulação temporomandibular induzidas por fraturas mandibulares: ensaio clínico randomizado

Objective: the aim of this study was to evaluate the efficacy of ultrasonography in diagnosis of tempromandibular joint soft tissue injury after mandibular osteosynthesis. Material and Methods: ten male patients (20 joint) with age ranged between 20-28 years were collected from those attending the outpatient clinic of Oral and Maxillofacial Surgery Department, Al-Kuwait Hospital, Sana'a University. Patients were divided into two groups according to the number of fracture line in the mandible. All patients were randomly assigned to diagnosis of the soft tissue changes of temporomandibular joint by either ultrasonography or magnetic resonance image preoperatively, after 2 weeks and 3 months postoperatively. Results: preoperatively, there was moderate agreement between ultrasonography and magnetic resonance image in the diagnosis of abnormal findings in both groups, the difference was not statistically significant. In group I, ultrasonography of the temporomandibular joint didn't detect any abnormal findings after mandibular osteosynthesis, meanwhile, magnetic resonance image recorded abnormal findings 40% and 20% after 2 weeks and 3 months respectively. In group II, the diagnosis of abnormal findings was the same (80%) pre and postoperatively by using magnetic resonance image however, the percent ofabnormal findings was reduced from 60% preoperatively to 40% postoperatively by using ultrasonography. Conclusion: the ultrasonographic image was not able to identify or diagnosis the disc position changes after indirect trauma. However, it had to some extent a role in the identification and diagnosis of effusion in temporomandibular joint. (AU)

Objetivo: o objetivo deste estudo consistiu em avaliar a eficácia da ultrassonografia no diagnóstico de lesões nos tecidos moles da articulação temporomandibular após a osteossíntese mandibular. Material e Métodos: dez pacientes do sexo masculino (no total de 20 indivíduos) de idades entre 20 e 28 anos foram selecionados do serviço ambulatorial do Departamento de Cirurgia Oral e Maxilo-facial, Hospital Al-Kuwait, Universidade de Sana'a. Os indivíduos incluídos foram distribuídos em dois grupos, de acordo com o número de linhas de fratura presentes na mandíbula. Todos os pacientes foram aleatoriamente alocados e divididos, com base no diagnóstico das alterações dos tecidos moles da articulação temporomandibular por ultrassonografia ou ressonância magnética no pré-operatório e em intervalos de 2 semanas e 3 meses no pós-operatório. Resultados: no pré-operatório, houve uma concordância moderada entre a ultrassonografia e a ressonância magnética no diagnóstico de achados anormais em ambos os grupos; a diferença não foi estatisticamente significativa. No grupo I, a ultrassonografia da articulação temporomandibular não revelou quaisquer achados anormais após a osteossíntese mandibular, enquanto a ressonância magnética registou achados anormais em 40% e 20% dos casos após 2 semanas e 3 meses, respectivamente. No grupo II, o diagnóstico das anormalidades por ressonância magnética foi o mesmo (80%) no pré e pós-operatório; contudo, a percentagem de casos anormais por ultrassonografia foi reduzida de 60% no pré-operatório para 40% no pós-operatório. Conclusão: a imagem ultrassonográfica não foi capaz de detectar alterações de posição do disco após trauma indireto. Entretanto, em certa medida, contribuiu para a identificação e diagnóstico de efusão na articulação temporomandibular (AU)

Recurring oral erythema multiforme-like lesions elicited by COVID-19 infection: a case report / Lesões semelhantes a eritema multiforme oral recorrente induzidas por infecção por COVID-19: relato de caso

Oral mucosa could be the first site infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ­the causative agent of coronavirus disease 2019 (COVID-19). Indeed, different oral and paraoral lesions, conditions and symptoms have been reported in patients with COVID-19. Experts thought that such oral lesions could be secondary to the COVID-19-associated deterioration of systemic health or due to treatments of COVID-19. We present here a case of a 24-year-old male presented with painful multiple ulcers involving the labial and buccal mucosae bilaterally after a while of feeling very mild symptoms that laboratory-confirmed by reverse-transcription polymerase chain reaction to be COVID-19. Involvement of eyes was also reported. The above clinical presentation was consistent with minor erythema multiform. Many topical preparations were prescribed but with limited improvement. Hence, oral prednisolone was prescribed with a 40-mg loading dose that was tapered by 10 mg every 3 days. Complete healing of oral mucosa was observed on the 10 day. Strikingly, the patient got affected with the second episode of similar oral lesions 5 months later without any apparent triggering factors, suggestive a long term effects of COVID-19 in a subset of patients. The present case report provides dentists with useful information and increases their awareness regarding possible involvement of oral cavity with multiple ulcerative lesions associated with COVID-19 (AU)

A mucosa oral pode ser o primeiro local infectado com a síndrome respiratória aguda grave coronavírus 2 (SARS- CoV-2) ­ o agente causador da doença por coronavírus 2019 (COVID-19). De fato, diferentes lesões, condições e sintomas orais e paraorais foram relatados em pacientes com COVID-19. Os especialistas pensavam que essas lesões orais poderiam ser secundárias à deterioração da saúde sistêmica associada ao COVID-19 ou devido a tratamentos do COVID-19. Apresentamos aqui um caso de um homem de 24 anos que apresentou múltiplas úlceras dolorosas envolvendo bilateralmente as mucosas labial e bucal após um tempo sentindo sintomas muito leves que foram confirmados laboratorialmente pela reação em cadeia da polimerase de transcrição reversa como COVID-19. O envolvimento dos olhos também foi relatado. A apresentação clínica acima foi compatível com eritema multiforme menor. Muitas preparações tópicas foram prescritas, mas com melhora limitada. Assim, foi prescrito prednisolona oral com uma dose inicial de 40 mg que foi reduzida em 10 mg a cada 3 dias. A cicatrização completa da mucosa oral foi observada no 10º dia. Surpreendentemente, o paciente foi afetado com o segundo episódio de lesões orais semelhantes 5 meses depois, sem nenhum fator desencadeante aparente, sugerindo efeitos de longo prazo do COVID-19 em um subconjunto de pacientes. O presente relato de caso fornece aos dentistas informações úteis e aumenta sua conscientização sobre o possível envolvimento da cavidade oral com múltiplas lesões ulcerativas associadas ao COVID-19 (AU)

Oral health status of female hospitalized psychiatric patients in Jazan: A Case-control study / Estado de saúde bucal de pacientes psiquiátricas hospitalizadas em Jazan: Um Estudo de caso-controle

Objectives: Poor oral health is an important determinant of general health in patients with mental illnesses. The present study was conducted to evaluate the dental and periodontal status of hospitalized female psychiatric patients in Jazan city, Saudi Arabia. Material and Methods: This study included 82 subjects: 37 psychiatric female patients, and 45 age- and gender- matched healthy controls. Dental caries experience (decayed, missing, and filled teeth index ( DMFT ) and periodontal health status were recorded. SPSS version 21 was used for data analysis, and p-value < 0.05 was considered statistically significant. Results: The mean ages were comparable among the two groups. Psychiatric patients showed poor oral hygiene practices, with only 56.6% reported regularly brushing their teeth as compared with 82.2% of controls (P < 0.05). Control subjects had significantly higher DMFT mean scores than psychiatric female patients. However, psychiatric patients had significantly higher mean scores of missing teeth (M component) and lower restored teeth (F component) as compared with controls. Moreover, the mean attachment loss scores were significantly higher in the psychiatric group (0.76±1.58) compared with controls (0.23; 0.44 p < 0.01). Conclusion: Psychiatric patients showed poor oral hygiene practices and a high prevalence of untreated dental caries and periodontal diseases. Effective oral health promotion strategies need to be implemented to improve the oral health and oral health practices of this group of people. (AU)

Objetivo: A má saúde bucal é um importante determinante da saúde geral em pacientes com doenças mentais. O presente estudo foi realizado para avaliar o estado dentário e periodontal de pacientes psiquiátricos do sexo feminino hospitalizados na cidade de Jazan, Arábia Saudita. Material e Métodos: Este estudo incluiu 82 indivíduos: 37 pacientes psiquiátricas do sexo feminino e 45 controles saudáveis pareados por idade e gênero. A experiência de cárie dentária (índice de dentes cariados, perdidos e obturados (CPOD) e o estado de saúde periodontal foram registrados. O progama SPSS versão 21 foi usado para a análise dos dados, e o valor de p <0,05 foi considerado estatisticamente significativo. Resultados: As médias das idades foram comparáveis entre os dois grupos. Pacientes psiquiátricos mostraram práticas de higiene bucal precárias, sendo que apenas 56,6% relataram escovar os dentes regularmente, em comparação com 82,2% dos controles (P <0,05). Os indivíduos controle tiveram pontuações médias de CPOD significativamente mais altas do que as pacientes psiquiátricas. Os pacientes tiveram escores médios significativamente maiores de dentes perdidos (componente P) e dentes restaurados menores (componente O) em comparação com os controles. Além disso, os escores médios de perda de inserção foram significativamente maiores no grupo psiquiátrico (0,76 ± 1,58) em comparação com os controles (0,23 ± 0,44;p <0,01). Conclusão: Pacientes psiquiátricos apresentaram práticas inadequadas de higiene bucal e uma alta prevalência de cárie dentária e doença periodontal não tratada. Estratégias eficazes de promoção da saúde bucal precisam ser implementadas para melhorar a saúde bucal e as práticas de saúde bucal desse grupo de pessoas (AU)

Management of isolated lateral malleolar fracture

Background: fractures of the lateral malleolus are the most common type of fracture. Various methods of lateral malleolar fixation have been utilized, all with acceptable results

Aim of the Work: to focus light on important modalities in management of isolated lateral malleolar fracture considering the advantages, the disadvantages and determine different protocol of management regarding the most recent guidelines for this group of patients

Patients and Methods: this study was conducted on twenty patients with fresh isolated lateral malleolar fracture. No or only minimal pain on the medial side was also a prerequisite, safeguarding against a ligamentous SE IV injury of the deltoid ligament. The patients were 4 men and 16 women with a mean age of 36 [22-50] years old

Results: all fractures united within an average time to union of 8.2 weeks. in all patients the average time to full weight bearing was 7.2 weeks. Most of complications were minor and resolved within 21 days

Conclusion: good anatomical reduction is essential for good clinical outcome irrespective of the type of fracture. Nevertheless, if an acceptable reduction cannot be achieved using closed techniques, one should proceed with open reduction and internal fixation without hesitation

effect of augmentation of local anesthetics with fentanyl or tramadol on the quality of supraclavicular brachial plexus blockade

Background: the effects of the addition of fentanyl or tramadol to a combination of lidocaine and bupivacaine on the quality of supraclavicular brachial plexus block [BPB] were evaluated

Methods: sixty patients scheduled for upper limb surgery were randomized into three equal groups [n=20]. The control group [C] received 20 ml 0.5% bupivacaine plus 10 ml 2% lidocaine for BPB, whereas the other groups received 20 ml 0.25% bupivacaine, 10 ml 2% lidocaine, plus either 100 ug fentanyl [group F] or 100 mg tramadol [group T]. The injected volume was completed to 40 ml using normal saline in all groups. Onset times of sensory block [analgesia and anesthesia] and motor block [paresis and paralysis], total times of surgery, analgesia, anesthesia, and motor block were recorded. Patients and surgeons satisfaction with the blockade, and the occurrence of adverse events were noted

Results: onset times of analgesia, anesthesia, paresis, and paralysis were comparable in the studied groups. The duration of analgesia in group F [16.4 [0.9] h] was comparable to that in group C [15.6 [0.8] h], and both were significantly longer than in group T [12.8 [1.2] h; P <0.05]. A significantly shorter duration of anesthesia was found in group F [7.8 [1.4] h] as compared with group C [9.3 [1.3] h], and in group T [6.7 [2.1] h] as compared with the other groups [P <0.05]. Group F and group T were associated with comparable duration of motor block [6.3 [0.7] h and 5.8 [1.2] h, respectively], and both were significantly less than in group C [8.5 [1] h; P <0.05] All groups were comparable regarding patients and surgeons satisfaction with the blockade, and incidence of adverse events [nausea and vomiting; one patient in group C, and shoulder pain; one patient in group T]

Conclusion: the addition of fentanyl to a lidocaine low dose bupivacaine Combination for supraclavicular BPB achieved comparable analgesic efficacy with that of a lidocaine - high dose bupivacaine combination, with a faster recovery of motor power. Although its analgesic efficacy was not parallel to that of fentanyl, tramadol provided fair duration of analgesia, with no difference from the other groups regarding the overall satisfaction of patients and surgeons with the quality of blockade

Accuracy of the triple test in the diagnosis of palpable breast masses in Saudi females

For patients who present to clinicians with palpable breast lesions, the "triple test:" [physical examination, mammography and fine-needle aspiration cytology] can be employed to provide accurate diagnosis. In this study, the sensitivity, specificity and predictive values of triple test components were studied separately and in combination. Material and During the study period [from January 1998 to December 1999], 140 patients with palpable breast masses were subjected to all components of the triple test followed by confirmatory open biopsy. Physical examination showed 82.6% sensitivity, 97.3% specificity and 86.4% positive predictive value. Mammography showed 87.5% sensitivity, 97.3% specificity and 87.5% positive predictive value and fine-needle aspiration cytology [FNAC] showed 91.7% sensitivity, 100% specificity and 100% positive predictive value in concordant cases [elements had either all malignant or all benign results]. The triple test was 100% accurate in the diagnosis of palpable breast lesions when all three elements were concordant. Based on these results, we recommend elimination of the confirmatory open biopsy, which will result in reduced expenses and morbidity compared with open biopsy

Non-Invasive preoperative predictors of choledocholithiasis before laparoscopic cholecystectomy in Saudi patients with symptomatic cholelithiasis

Despite the rapid implementation and application of laparoscopic cholecystectomy [LC], predicting which patient will have common bile duct [CBD] stones can be challenging. It is not clear which is the safest and most accurate form of pre operative detection of CBD stones in patients undergoing LC. Our study demonstrates the value of using preoperative indicators to detect the patients with CBD stones especially in LC era where the surgeon cannot manually palpate the CBD Material And We conducted a prospective preoperative study on 250 patients with symptomatic gallstones who undergone LC from October 1998 till December 1999 at King Fahad Hospital, Hofuf. Clinical history, liver functions tests [LFTs] and ultrasonography [US] were performed in all cases prior to operation. Preoperative endoscopic retrograde cholangio- pancreatography [ERCP] was performed in 34 patients [13.6%] in whom CBD stones were suspected by at least one abnormality on US and/or LFTs or clinical indicator [history of jaundice or pancreatitis]. Prevalence rate of CBD stones in this study was 6.8% as defined by the presence of stones by ERCP. The sensitivity, specificity, positive predictive value [PPV] and negative predictive value [NPV] respectively for each preoperative indicator were calculated: a history of jaundice [34%, 84%, 36%, 82%], a history of pancreatitis [20%, 98%, 75%, 82%], US [80%, 82%, 55%, 94%] and LFTs [any elevation] [94%, 75%, 50%, 98%]. Preoperative US and LFTs together with history of jaundice or pancreatitis are the best predictive factors for the state of CBD. Preoperative ERCPshould be restricted to patients with a high probability of CBD stones as suggested by a combination of history, US and LFTs

Budd chiari syndrome: experience at king faisal specialist hospital and research center, Riyadh, Saudi Arabia

Budd-chiari syndrome [BCS] is rare disorder, varied in etiology, inconsistent in presentation, unpredictable in progression, and challenging in therapy. Aim of study: The aim of this study is to review experience of Budd- Chiari syndrome at KFSH, Riyadh; over at ten-year period. In a retrospective study using a computer data search of the medical records from May 1990 to May 2000, 43 patients' charts suspected of BCS were reviewed. 29 patients were found to have BCS, diagnosed by Doppler ultrasound, venography, MRI, or CT with or without liver biopsy. Findings: Of the 29 patients, 18 were male [62.1%] and 11 were female [37.9%]; mean age was 35.4 [range 17-69 years]. Nine patients had Behect's disease seven patients had malignancy [five HCC, one melanoma and one hypernephroma]. Eight patients had antiphospholipid syndrome, two patients one melanoma and one hypernephroma]. Eight patients had antiphospholipid syndrome, two patients had no known cause and three [one related to trauma, the other related to protein C deficiency and the third related nephrotic syndrome]. Nineteen patients presented acutely with abdominal pain, progressive ascites and hepatomegaly. Ten patients had subacute presentation mimicking cirrhosis of liver. Five patients had web in the intrahepatic IVC or ostium HV and the remaining 24 patients had thrombosis of hepatic veins. Five patients received surgical shunts, three had balloon dilatation of webs, 11 had anticoagulant therapy and seven patients had symptomatic treatment. Eleven patients died, six of them had malignancy, two died while awaiting liver transplantation and three died with fulminant hepatic failure. Fourteen patients are still on follow-up. Budd Chiari syndrome in a Saudi Arabia is related to a defined cause in majority of patients [92%]. Behcet's disease is a dominant cause of BCS in Saudi Arabia. This is in contrast to world literature where around 50% of patients are of unknown etiology