Arthroscopic discopexy versus natural course of temporomandibular joint anterior disc displacement: a longitudinal study of clinical and radiological outcomes.

The aim of this study was to assess the various outcomes of arthroscopic discopexy compared to the natural course of anterior disc displacement (ADD) longitudinally in the same patients. A retrospective review was performed of 108 patients (152 joints) who experienced the natural course of ADD for a period of time and then underwent arthroscopic discopexy. The outcome was evaluated clinically and by magnetic resonance imaging. The natural course of ADD showed significant deterioration in pain, diet, and quality of life, and also a significant reduction in inter-incisal opening (all P < 0.001), while significant improvements in all clinical parameters were observed at the final postoperative follow-up (all P < 0.001, compared to the last preoperative visit). During the natural course, there was a significant shortening of condylar height, mandibular height, and disc length, and an increase in disc displacement distance (all P < 0.001). Postoperative follow-up revealed the restoration of condylar height and mandibular height, and all discs were significantly repositioned with an increased disc length (unfolded) (all P < 0.001). Bearing in mind the assumption of a low evidence base due to bias resulting from the retrospective non-double-blinded study design and the variable duration of the natural disease course prior to surgery, this study found that the natural course of ADD led to degenerative changes in the joint structures and clinical symptoms, whereas arthroscopic discopexy led to a restoration of the bony structures and the alleviation of clinical symptoms.

Pulmonary tuberculosis at Patan Hospital, Nepal: One year audit.

BACKGROUND: Globally, Tuberculosis (TB) is one of the top 10 causes of death. In Nepal, poverty and malnutrition aggravate the burden of TB. To identify Mycobacterium tuberculosis sputum is the best sample to identify the bacterium which is helpful for diagnosis. The aim of this study is to identify the situation, burden and challenges of pulmonary tuberculosis in low-middle income country like Nepal. METHOD: A retrospective-audit with reliable-secondary-data of one year was collected (n = 4131). Descriptive-analysis was performed using frequency, percentage and analytical using chi-square-test. Level of significance was set at p < 0.05. Ethical Approval was obtained from IRC-PAHS. RESULT: The prevalence of notified/suspected cases was highest among the patients having >60 years of age 1344(32.54%) and least among the patients with ≤15 years of age 239(5.79%). The male had 1.67 times more smear-positive pulmonary TB cases. Among the AFB-positive cases, smear 3+ was seen in most of the cases 69(38.54%) followed by smear 1+ and smear 2+ in 56(31.28%) and 54(30.16%) respectively. CONCLUSION: The prevalence of smear-positive pulmonary TB case is higher in male. Smear 3+ is seen in most of the followed by smear 1+ and smear 2+. The Burden of Pulmonary TB is more among adult and old-age-people and its control is a challenge for developing and low-middle income countries like Nepal.

Determining the risk relationship associated with inferior alveolar nerve injury following removal of mandibular third molar teeth: A systematic review.

PURPOSE: This study analyzes the risk factors associated with the incidences of inferior alveolar nerve (IAN) injury after surgical removal of impacted mandibular third molar (IMTM) and to evaluate the contribution of these risk factors to postoperative neurosensory deficits. MATERIALS AND METHODS: An exhaustive literature search has been carried out in the COCHRANE library and PubMed electronic databases from January 1990 to March 2019 supplemented by manual searching to identify the related studies. Twenty-three studies out of 693 articles from the initial search were finally included, which summed up a total of 26,427 patients (44,171 teeth). RESULTS: Our results have been compared with other current available papers in the literature review that obtained similar outcomes. Among 44,171 IMTM extractions performed by various grades of operators, 1.20% developed transient IAN deficit and 0.28% developed permanent IAN deficit respectively. Depth of impaction (P<0.001), contact between mandibular canal (MC) and IMTM (P<0.001), surgical technique (P<0.001), intra-operative nerve exposure (P<0.001), and surgeon's experience (P<0.001) were statistically significant as contributing risk factors of IAN deficits. CONCLUSION: Radiographic findings, such as depth of impaction, proximity of the tooth to the mandibular canal, surgical technique, intra-operative nerve exposure, and surgeon's experience were high risk factors of IAN deficit after surgical removal of IMTMs.

Hyponatremia in Patients with Community Acquired Pneumonia.

INTRODUCTION: Community acquired pneumonia is one the frequent cause of hospital admissions. Whereas, hyponatremia is a common electrolyte abnormality in hospitalized patients and has been shown to be associated with considerable morbidity and mortality. We aim to studyt the association of hyponatremia with community acquired pneumonia in terms of morbidity and mortality. METHODS: A prospective observational hospital based study was conducted in a hospital for a year. All patients with a diagnosis of community acquired pneumonia and admitted in medicine ward, were included. Patients with diarrhea, known Chronic Kidney Disease, Heart Failure, Cirrhosis of Liver, Malignancy, taking diuretics, chemical pneumonitis, interstitial pneumonias and other debilitating disease were excluded. RESULTS: Among the 72 cases of CAP, 61% were females and 39% were males. The mean age of patients was 51.3 years, 22 (30.55%) patients had severe CAP. A total of 7 cases expired with an overall mortality of 13.7%. The mortality risk increased with increasing CURB-65 score; CURB-65 score 0, 0%; CURB-65 score 1, 0%; CURB-65 score 2, 0%; CURB-65 score 3, 10%; CURB-65 score 4, 33%; CURB-65 score 5, 100%. i.e higher the CURB-65 score, higher the death rate of CAP patients (p<0.05). Hyponatremia was a common occurrence at hospital admission with an incidence of 36.11%. Hyponatremia at hospital admission was also associated with a longer length of hospital stay in cured CAP patients. The mean length of hospital stay was 4.3 days. CONCLUSIONS: High CURB-65 scores and lower values of serum sodium at admission in patients of CAP are associated with adverse outcomes both in terms of mortality and longer length of hospital stay. CURB-65 score should be incorporated into assessment of CAP and sodium of the patients during admission.

Darier disease in Israel: combined evaluation of genetic and neuropsychiatric aspects.

BACKGROUND: Darier disease (DD) is a rare genodermatosis caused by heterozygous mutations in the ATP2A2 gene. It has been associated with neuropsychiatric manifestations. OBJECTIVES: To investigate the genetic basis of Israeli patients with DD, and its association with the neuropsychiatric phenotype. METHODS: A cohort of 32 families comprising 74 affected individuals and 13 unaffected family members was recruited from the Haemek Dermatology Department and other dermatology clinics in Israel. The individuals were evaluated by detailed questionnaires, physical examination and genetic analysis. The main outcome measures were genetic mutations, psychiatric profile and their association. RESULTS: Twenty-three mutations in ATP2A2 were scattered over the entire gene, 14 of them novel. Two families shared the same mutation. Twenty-one patients (28%) had a history of psychiatric disorders, most of them mood disorders. Another seven patients (9%) were highly suspected of having a psychiatric disorder; 21 (28%) reported suicidal thoughts and five (7%) had attempted suicide. The psychiatric phenotype demonstrated inter- and intrafamilial variability, and was not associated with disease severity, family history of psychiatric disease or mutation location. CONCLUSIONS: The cohort demonstrated genetic heterogeneity with no mutation cluster along the gene, and a high prevalence of psychiatric disorders. Although no clear genotype-phenotype correlation was found, the results point to a major effect of genetic background on psychiatric phenotype, together with other modifiers.

Impact of antipsoriatic therapy on endothelial function.

BACKGROUND: Endothelial function (EF) impairment is one of the first events in the process of atherosclerosis, which is known to be associated with psoriasis. Nevertheless, the effect of antipsoriatic treatments, some of them with atherogenic risks, on cardiovascular morbidity and EF is still unclear. OBJECTIVES: To investigate the effect of short-term antipsoriatic treatments on EF values as a potential marker of their effect on cardiovascular morbidity. METHODS: EF was evaluated in 26 patients with moderate-to-severe psoriasis by measuring microvascular blood flow, expressed as the reactive hyperaemia index (RHI), before and after phototherapy (8 weeks) or systemic antipsoriatic treatment (12 weeks). RESULTS: Antipsoriatic intervention was effective (46% achieving ≥ 75% improvement in Psoriasis Area and Severity Index), while the average RHI did not improve during the study (1·73 ± 0·48. vs. 1·66 ± 0·35, average difference -0·12 ± 0·43, not significant). Patients with baseline preserved EF exhibited a decline in RHI (difference -0·2 ± 0·4, P = 0·053), while patients with abnormal baseline RHI presented nonsignificant RHI improvement (RHI difference 0·1 ± 0·2). CONCLUSIONS: There was no positive effect on EF of short-term antipsoriatic treatment. It is possible that a longer period of treatment and EF evaluation would uncover a positive endothelial effect, especially in patients with baseline abnormal EF.

Radiological approach to a child with hip pain.

Hip pain in a child can be a diagnostic challenge partly because of barriers to communication in the paediatric age group. Pain or limp may result from infective, inflammatory, traumatic, neoplastic, or developmental causes. A meticulous history and detailed clinical examination guide the radiological investigation in the appropriate direction. The age of the child further helps to narrow the differential as certain diseases are more common in certain age groups. In most patients plain radiograph and/or ultrasound is adequate. Ultrasound has the added advantage of being real time and can be used to guide aspiration. Magnetic resonance imaging (MRI) and bone scintigraphy can be used for problem solving, looking for multifocal disease, and staging. Computed tomography (CT) has a limited role to play because of the risks associated with ionizing radiation. In this review we discuss the approach to imaging a child who presents with pain in the hip or with a limp. The various common and rare, but important, diseases are illustrated with examples from our clinical practice.

Chronic recurrent multifocal osteomyelitis mimicking osteoid osteoma.

In this article we illustrate an unusual case of chronic recurrent multifocal osteomyelitis (CRMO) in a 9 year old girl who presented with right thigh pain. The initial plain radiographs were normal. The white cell count was normal and there was a mild rise in C-reactive protein. Cross sectional imaging of the right femur showed a lesion with features suggestive of osteoid osteoma. However, when the lesion was excised, the appearances on histopathological examination were non-specific showing chronic inflammatory cells and the microbiological testing revealed no organisms. Six months later, this child presented with right shoulder pain and the subsequent imaging demonstrated bilateral clavicular lesions. At this stage, the diagnosis of CRMO was made based on the combination of the clinical, radiological, histopathological and microbiological features. This case demonstrates that the cross sectional imaging features of the bony lesion in CRMO can mimic osteoid osteoma.

Formulation development and release studies of indomethacin suppositories.

Indomethacin suppositories were prepared by using water-soluble and oil soluble suppository bases, and evaluated for in vitro release by USP I and modified continuous flow through bead bed apparatus. Effect of the Tween 80 (1% and 5%) was further studied on in vitro release of the medicament. Release rate was good in water-soluble suppositories bases in comparison to oil soluble suppositories bases. Release was found to be greater in modified continuous flow through bead bed apparatus. When surfactant was used in low concentration then release rate was much greater, as compared to high concentration. When stability studies were performed on the prepared indomethacin suppositories it was found that suppositories made by water-soluble base had no significant changes while suppositories prepared by oil soluble bases, had some signs of instability.