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Case Reports in Critical Care 2023As the incidence of bacterial myositis and pyomyositis in the United States is rising, we aim to highlight the presentation of bacterial myositis which is known as a...
As the incidence of bacterial myositis and pyomyositis in the United States is rising, we aim to highlight the presentation of bacterial myositis which is known as a great imitator in tropical regions. This is a case report of a 61-year-old female patient with poorly controlled diabetes who presented initially with lateral hip pain and tenderness. This was initially believed to be septic arthritis and warranted arthrocentesis. What makes this case interesting is that what was believed to be a primary community-acquired MRSA myositis, which progressed to a life-threatening septic shock, happened in a nontropical area (Northeastern USA) and in a patient with no underlying recent muscle injury. This case serves to remind clinicians that infectious myositis is gaining more incidence in nontropical regions and can masquerade as septic arthritis, requiring a high index of suspicion. Normal muscle enzymes like CK and aldolase do not rule out myositis.
PubMed: 36895204
DOI: 10.1155/2023/5623876 -
International Journal of Environmental... Feb 2022Learning modifications particularly increased due to the SARS-CoV-2 pandemic, which made it necessary to offer distance health education for many months. Social media... (Review)
Review
Learning modifications particularly increased due to the SARS-CoV-2 pandemic, which made it necessary to offer distance health education for many months. Social media allows students to have interactive activities such as discussing specific subjects or sharing data with each other, and also to have interactions with their teachers and tutors. So, we aimed to compare the effects of the use of social media on knowledge, skills and perceptions in health students compared to other methods. We performed a systematic review on PubMed, ScienceDirect and Embase about comparative learning methods using social media. The search followed PRISMA guidelines, and the quality assessment of the studies was performed using the Medical Education Research Quality instrument (MERSQI). Eight studies were analyzed including 1014 participants. Mean age ranged from 19.9 to 23.4 years, and 70% were females. About 54.4% of the participants were medical students and 20.9% were dental students. The mean MERSQI was 11.7 ± 2.6. Various subjects were included-anatomy, cultural competences, sterile surgical techniques, radiology, arthrocentesis, medical pathologies and cariology. As far as knowledge evaluation was concerned, we found that the use of social media may have had a positive effect from a short-term point of view but results concerning skills were less consistent across studies. Students usually had a positive perception of the use of social media as a complementary method but not as a complete alternative so it is not excluded that this effect might result from an increase in working time. The impact on patient care should also be assessed in future studies.
Topics: Adult; COVID-19; Education, Medical; Female; Humans; SARS-CoV-2; Social Media; Students, Medical; Young Adult
PubMed: 35206401
DOI: 10.3390/ijerph19042205 -
Journal of Clinical Medicine May 2023The aim of this review was to systematically map the research on the intra-articular administration of injectable platelet-rich fibrin (I-PRF) to the temporomandibular... (Review)
Review
The aim of this review was to systematically map the research on the intra-articular administration of injectable platelet-rich fibrin (I-PRF) to the temporomandibular joints (TMJs). Medical databases covered by the ACM, BASE, Google, NLM, and ResearchGate were searched on 23 February 2023. The assessment of the level of evidence was based on the Oxford Center for Evidence-Based Medicine 2011 scale. The risk of bias was assessed for randomized controlled trials with the RoB2 tool. Extracted data were tabulated, and the changes in effect values were calculated. A total of eight studies qualified, of which five trials on 213 patients were randomized and controlled (RCTs). In each of the RTC study groups, arthrocentesis was performed, and 1-2 mL per joint of I-PRF (700 rpm/3 min/60 g centrifugation) was administered. Articular pain in three months decreased to 0-25% of the initial pre-interventional values in the study and 38-50% in the control groups. Mandible mobility increased to 121-153% and 115-120% in the I-PRF groups and controls, respectively. The main limitations of the evidence were the small number of RCTs and the lack of any RCT study groups receiving I-PRF without prior arthrocentesis. In conclusion, supplementing the temporomandibular joint rinsing with I-PRF administration further relieves pain and improves mandible mobility. The lack of RCTs on the intra-articular administration of I-PRF as a stand-alone procedure encourages further research. This research received no external funding. The review protocol has not been previously published.
PubMed: 37176766
DOI: 10.3390/jcm12093326 -
Journal of Functional Morphology and... Mar 2020Arthrocentesis in temporomandibular joint disorders can be associated with the intra-articular infiltration of various drugs with the objective of increase treatment...
Arthrocentesis in temporomandibular joint disorders can be associated with the intra-articular infiltration of various drugs with the objective of increase treatment efficacy. The aim of this study was to evaluate the clinical indexes variation in patients affected by temporomandibular joint disorders treated with arthrocentesis and sodium hyaluronate (SH) injections. A total of 28 patients suffering from temporomandibular joint disorders underwent one cycle of five arthrocentesis and infiltrations of sodium hyaluronate. Spontaneous mouth opening improved from 36.3 ± 7.5 mm to 45.1 ± 1.9 mm at six months follow-up. A significant reduction in the pain at rest and during mastication mean values emerged at follow-up ( < 0.0001). The mean masticatory efficiency, evaluated through a visual analogic scale, showed improvement at the follow-up period, highlighted by the increase of mean value from a baseline of 3.1 ± 1.2 to a mean value of 8.5 ± 1.2 ( < 0.0001). The mean severity of the joint damage at baseline time was 2.4 ± 0.9 and decreased to 0.4 ± 0.3 at the end of the follow-up period. The decrease in values is confirmed by statistical test ( < 0.05). Our data show how arthrocentesis integrated with sodium hyaluronate infiltrations performed under local anesthesia is a valid method of treating temporomandibular joint disorders.
PubMed: 33467234
DOI: 10.3390/jfmk5010018 -
Medicina (Kaunas, Lithuania) May 2023Emergency department (ED) overcrowding is a public health crisis that affects patient care quality. Space management in the ED can affect patient flow dynamics and...
Emergency department (ED) overcrowding is a public health crisis that affects patient care quality. Space management in the ED can affect patient flow dynamics and clinical practice. We proposed a novel design of the "emergency procedure zone" (EPZ). The purpose of the EPZ was to provide an isolated area for clinical practice and procedure teaching, to ensure a secure area with adequate equipment and monitors, and safeguard patient privacy and safety. This study aimed to analyze the impact of the EPZ on procedural practice and patient flow dynamics. This study was conducted at the ED of a tertiary teaching hospital in Taiwan. Data were collected from 1 March 2019 to 31 August 2020 (pre-EPZ period) and from 1 November 2020 to 30 April 2022 (post-EPZ period). Statistical analyses were performed using IBM SPSS Statistics software. This study focused on the number of procedures and length of stay in the emergency department (LOS-ED). Variables were analyzed using the chi-square test and Mann-Whitney U test. Statistical significance was defined as < 0.05. There were 137,141 (pre-EPZ period) and 118,386 (post-EPZ period) ED visits recorded during this period. The post-EPZ period showed a significant increase in central venous catheter insertion, chest tube or pigtail placement, arthrocentesis, lumbar puncture, and incision and drainage procedures ( < 0.001). For patients who were directly discharged from the ED, the post-EPZ period also had a higher percentage of ultrasound studies performed in the ED and a shorter LOS-ED for patients who were directly discharged from the ED ( < 0.001). The establishment of an EPZ in the ED has a positive impact on procedural efficiency. The EPZ improved diagnosis and disposition efficiency, shortened the length of stay, and provided benefits such as improved management, patient privacy, and teaching opportunities.
Topics: Humans; Retrospective Studies; Length of Stay; Emergency Service, Hospital; Time Factors; Hospitals, Teaching
PubMed: 37241133
DOI: 10.3390/medicina59050901 -
Cureus Sep 2023Temporomandibular joint (TMJ) disorders present complex challenges in pain management and functional restoration. This review delves into the innovative approach of... (Review)
Review
Temporomandibular joint (TMJ) disorders present complex challenges in pain management and functional restoration. This review delves into the innovative approach of using platelet-rich plasma (PRP) and hyaluronic acid (HA) combination therapy in TMJ arthrocentesis to address these issues. The potential benefits of this approach are highlighted through an exploration of mechanisms, clinical studies, safety considerations, and future directions. PRP's regenerative properties and HA's lubrication and anti-inflammatory effects offer a comprehensive solution to multifactorial TMJ pain and dysfunction. Clinical studies reveal significant pain reduction, improved mobility, and enhanced satisfaction in patients treated with PRP and HA. Although mild and transient adverse effects have been reported, the safety profile remains favorable. While the evidence is promising, more extensive randomized controlled trials are needed to establish sustained efficacy and safety. As research evolves, collaborative efforts among clinicians and researchers are crucial in realizing the potential of PRP and HA combination therapy, ultimately providing a novel pathway to alleviate TMJ-related pain and enhance patient well-being.
PubMed: 37868393
DOI: 10.7759/cureus.45646 -
The Medical Journal of Malaysia Mar 2021Septic arthritis (SA) occurrence for temporomandibular joint (TMJ) is rare. Pain, fever, swelling or loss of TMJ function are the typical presentation. The more common...
Septic arthritis (SA) occurrence for temporomandibular joint (TMJ) is rare. Pain, fever, swelling or loss of TMJ function are the typical presentation. The more common diagnosis for these presentations is internal derangement, osteoarthritis and rheumatoid arthritis. Therefore, TMJ septic arthritis is a challenging diagnosis and at risk of delayed diagnosis. We present a case of TMJ septic arthritis in a 46 year old Malay female with underlying hypertension and hypercholestrolemia, which was diagnosed as internal derangement in the initial presentation. The initial radiograph was normal. Arthrocentesis procedure had temporarily relieved the symptoms before progressive facial swelling developed after a week. Contrast enhanced computed tomography (CECT) brain revealed left TMJ abscess formation with left condylar erosion. Patient subsequently improved after wound debridement, left condylectomy and antimicrobial therapy.
Topics: Arthritis, Infectious; Female; Humans; Middle Aged; Pain; Temporomandibular Joint; Temporomandibular Joint Disorders; Tomography, X-Ray Computed
PubMed: 33742643
DOI: No ID Found -
Journal of Maxillofacial and Oral... Mar 2023Temporomandibular joint disc displacement disorders are a group of temporomandibular disorders beside from other inflammatory disorders and growth related disorders of... (Review)
Review
Efficacy of Arthrocentesis and Stabilization Splints in Treatment of Temporomandibular Joint Disc Displacement Disorder Without Reduction: A Systematic Review and Meta-analysis.
BACKGROUND
Temporomandibular joint disc displacement disorders are a group of temporomandibular disorders beside from other inflammatory disorders and growth related disorders of joint. The purpose of this analysis was to evaluate the efficacy of arthrocentesis procedure in comparison with stabilization splints used for disc displacement disorders without reduction.
MATERIALS AND METHODS
A systematic search was done in electronic databases (PubMed, Cochrane Central, Web of Science). In addition to this hand search of references and grey literatures was done. Qualities of randomized controlled clinical trials were assessed by Cochrane's tool for Systematic Reviews of Interventions and the Newcastle-Ottawa Scale was followed to assess the prospective and retrospective studies. Outcome variables pain (VAS) and maximum mouth opening were assessed by the software review manager 5.03.
RESULTS
A total of five studies were included in the review. Three studies showed greater improvement of symptoms in patients of arthrocentesis group in terms of maximum mouth opening, pain (VAS) value. Two other studies found no significant advantage of arthrocentesis over the other treatment protocol. The meta-analysis resulted in statistically significant difference between outcome variables favouring arthrocentesis group (VAS 1-10) (Mean Difference: 3.10; 95% CI 1.74, 4.45; ≤ .00001, Mean difference: 2.00; 95% CI 0.29, 3.71; = 0.02).
CONCLUSION
Arthrocentesis showed effective result in terms of increase in mouth opening and reduction of pain level compared to stabilization splint and other non-invasive approaches in patients with disc displacement disorders without reduction. Overall, results supported the rationale of using arthrocentesis in patients with disc displacement disorders without reduction.
PubMed: 36703686
DOI: 10.1007/s12663-021-01675-1 -
Journal of Children's Orthopaedics Jun 2022Pediatric septic arthritis is a surgical emergency and timely diagnosis prevents serious complications. To differentiate between septic hip and transient synovitis, the...
BACKGROUND
Pediatric septic arthritis is a surgical emergency and timely diagnosis prevents serious complications. To differentiate between septic hip and transient synovitis, the predictive value of four original Kocher criteria (fever, inability to bear weight, elevated serum white blood cell count, and elevated erythrocyte sedimentation rate) plus Caird's addition of elevated C-reactive protein have been studied, termed the modified Kocher criteria. These criteria have not been tested extensively on septic knee. This study tested the utility of the modified Kocher criteria in predicting septic knee while validating it for septic hip.
METHODS
A retrospective chart review was conducted of pediatric patients evaluated at a single institution for irritable hip or knee between 2009 and 2018. Patients who underwent arthrocentesis were included and the modified Kocher criteria were applied to all.
RESULTS
One hundred fifty-five patients (96 hips and 59 knees) were identified. One hundred four (67.1%) patients had septic arthritis with 44/59 (74.6%) of knees and 60/96 (62.5%) of hips. The strongest predictors for septic hip and knee were elevated C-reactive protein (odds ratio = 26.9, < 0.0001) and refusal to bear weight (odds ratio = 14.5, < 0.0001), respectively. For hips, 5/5 criteria produced a 100% positive predictive value for septic arthritis. For knees, the combination of inability to bear weight and elevated C-reactive protein had a positive predictive value of 89.7%.
CONCLUSION
While all five of the modified Kocher criteria are not predictive of pediatric septic knee, the combination of two specific factors (inability to bear weight and elevated C-reactive protein) is strongly predictive. This study validates previous work that the modified Kocher criteria are predictive of septic hip.
LEVEL OF EVIDENCE
level III.
PubMed: 35800650
DOI: 10.1177/18632521221106383 -
Clinics (Sao Paulo, Brazil) 2021Arthrocentesis is the simplest surgical intervention for the temporomandibular joint (TMJ). It can be performed on an outpatient basis at a low cost and with low...
OBJECTIVES
Arthrocentesis is the simplest surgical intervention for the temporomandibular joint (TMJ). It can be performed on an outpatient basis at a low cost and with low morbidity. The objective is to release the articular disc by disrupting the adhesion formed between its surfaces and the mandibular fossa through hydraulic pressure generated by irrigation of the upper compartment of the TMJ. Viscosupplementation with hyaluronic acid during or after arthrocentesis improves clinical outcomes, increases mouth opening, and reduces pain levels. The aim of this study was to evaluate the efficiency of arthrocentesis plus hyaluronic acid viscosupplementation through clinical examination and preoperative magnetic resonance imaging in patients with unilateral disc displacement without reduction (DDwoR).
METHODS
This analytical retrospective cross-sectional study clinically and radiologically evaluated 72 patients of both sexes with unilateral DDwoR. The following data were collected: sex, pain, age, duration of pain, maximum mouth opening, and patient pain perception on a visual analog scale. TMJ arthrocentesis was performed only once for each of the indicated joints. Data were collected before arthrocentesis (baseline) and at 7, 14, 30, 60, 90, and 180 days after the procedure (final evaluation).
RESULTS
Between the baseline and final evaluation, there was a significant reduction in pain (p=0.001) and restoration of articular function. In addition, there was a significant increase in maximum mouth opening (p=0.001).
CONCLUSION
Patients with DDwoR undergoing arthrocentesis combined with hyaluronic acid injection showed significant improvement in the perceived pain and maximum mouth opening in the mid-term follow-up periods.
Topics: Arthrocentesis; Cross-Sectional Studies; Female; Humans; Joint Dislocations; Male; Range of Motion, Articular; Retrospective Studies; Temporomandibular Joint Disc; Treatment Outcome; Viscosupplementation
PubMed: 33909828
DOI: 10.6061/clinics/2021/e2840