Mild untreated hypercholesterolaemia affects mechanical properties of the Achilles tendon but not gastrocnemius muscle.

Tendon xanthoma and altered mechanical properties have been demonstrated in people with familial hypercholesterolaemia. However, it is unclear whether mild, untreated hypercholesterolaemia alters musculotendinous mechanical properties and muscle architecture. We conducted a case-control study of adults aged 50 years and over, without lower limb injury or history of statin medication. Based on fasting low-density lipoprotein (LDL) cholesterol levels, 6 participants had borderline high LDL (>3.33 mmol/L) and 6 had optimal LDL cholesterol (<2.56 mmol/L). Using shear wave elastography, shear wave velocity (SWV) of the Achilles tendon and gastrocnemius medialis muscle (a proxy for stiffness), along with muscle fascicle length and pennation angle were measured under four passive tensile loads (0, 0.5, 1.0, 1.5 kg) applied via a pulley system. Differences between groups were found for tendon SWV but not muscle SWV, fascicle length or pennation angle. Participants with hypercholesterolaemia showed greater SWV (mean difference, 95 % CI: 2.4 m/s, 0.9 to 4.0, P = 0.024) compared to the control group across all loads. These findings suggest that adults with mild hypercholesterolaemia have increased tendon stiffness under low passive loads, while muscle was not affected. Future research is needed to confirm findings in a larger cohort and explore the impact of hypercholesterolaemia on tendon fatigue injury and tendinopathy.

2021 Asia-Pacific League of Associations for Rheumatology clinical practice guideline for treatment of gout.

BACKGROUND: Gout is the most prevalent inflammatory arthritis in the Asia-Pacific region and worldwide. This clinical practice guideline (CPG) aims to provide recommendations based on systematically obtained evidence and values and preferences tailored to the unique needs of patients with gout and hyperuricemia in Asia, Australasia, and the Middle East. The target users of these guidelines are general practitioners and specialists, including rheumatologists, in these regions. METHODS: Relevant clinical questions were formulated by the Steering Committee. Systematic reviews of evidence were done, and certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation methodology. A multi-sectoral consensus panel formulated the final recommendations. RESULTS: The Asia-Pacific League of Associations for Rheumatology Task Force developed this CPG for treatment of gout with 3 overarching principles and 22 recommendation statements that covered the treatment of asymptomatic hyperuricemia (2 statements), treatment of acute gout (4 statements), prophylaxis against gout flare when initiating urate-lowering therapy (3 statements), urate-lowering therapy (3 statements), treatment of chronic tophaceous gout (2 statements), treatment of complicated gout and non-responders (2 statements), treatment of gout with moderate to severe renal impairment (1 statement), and non-pharmacologic interventions (5 statements). CONCLUSION: Recommendations for clinically relevant scenarios in the management of gout were formulated to guide physicians in administering individualized care.

Update on Medications for Oral Sedation in the Oral and Maxillofacial Surgery Office.

Dental anxiety is a leading cause of postponing treatment and/or complete avoidance of professional oral care. Therefore, effective sedation and pain control are integral components of dental care for the fearful and anxious patient. The application of oral sedation aids the trained practitioner to provide care to the anxious dental patient and remains the safest, most established, and most commonly used route of drug administration. Proper training and understanding of pharmacologic properties allows for safe and effective application of analgesics and sedatives for oral sedation.

Soft Tissue Injury in Preparation for Implants.

Diagnosis and treatment planning are critical in preparation for implant placement. Adequate evaluation, preoperative imaging, and surgical planning minimize early and late-stage soft tissue injuries. Correct placement of dental implants can be challenging with several contributing factors such as lack of proper preoperative soft tissue evaluation and surgical experience in dealing with soft tissue incisions and flap reflection, resulting in injury and complications involving the soft tissues.

Is pregnancy an immunological contributor to severe or controlled COVID-19 disease?

Since its emergence in Wuhan as a novel coronavirus disease, it has taken only a few months since January 2020 for it to be recognized as a widespread COVID-19 pandemic which has contributed to global health devastation. As pointed out by health experts, it is a once in a century pandemic of our times. Clinical observations so far indicate that the older population and immune compromised individuals, particularly in African American and Hispanic/Latino communities, are at much higher risk for infection with this novel coronavirus. In this regard, pregnancy offers an altered immunity scenario which may allow severe COVID-19 disease. The literature is so far highly conflicting on this issue. This review will offer a conceptual basis for severe or controlled disease and address trepidations for pregnant women associated with COVID-19 pandemic, particularly in the comparative context of clinical consequences of other coronaviruses such as SARS and MERS. We will highlight the possible consequences of COVID-19 on the general health of pregnant women as well as its possible effects at the maternal-fetal interface. For the placenta-related pathology, we will focus our discussion on the temporal expression of ACE2 throughout gestation for possible propagation of SARS-CoV-2 in the placenta in infected women and ensuing consequences.

Delirio de pacientes con síndrome coronario agudo en una unidad de cuidados intensivos / Delirium in patients with acute coronary syndrome in an intensive care unit

Introducción: el delirio es una variación aguda del estado de conciencia, frecuente en unidad de cuidado intensivo (UCI). Su incidencia varía, presentando diferentes características clínicas correlacionadas. Objetivo: determinar la incidencia de delirio en pacientes con Síndrome Coronario Agudo (SCA) en una UCI, las características clínicas asociadas, y su correlación con el grado de severidad de la enfermedad. Material y métodos: estudio descriptivo, pros-pectivo, cuantitativo. Se aplicó herramienta diagnóstica CAM-ICU, a 24 pacientes para detectar la presencia de delirio en casos de síndrome coronario. Resultados: la incidencia de delirio estimada fue de 4 casos por cada 1000 de Síndrome Coronario Agudo; la edad promedio para pacientes con delirio fue 67 años. El valor de Cramérs V obtenido de 0.589 sugiere una moderada relación entre "X" (la situación clínica medida con Apache II) y "Y" (la presencia de delirio identificada con CAM-ICU); al igual que la relación entre el delirium y la evaluación objetiva de la gravedad utilizando la escala APACHE-II (Phi 283). Conclusión: el delirio fue una manifestación neu-rológica de baja incidencia entre los pacientes con SCA internados en UCI; el coeficiente de Cramérs V obtenido indico intensidad moderada en la asociación estadística entre delirium y severidad del cuadro clínico.