Advantages and limitations of the endoscopic tympanoscopy a prospective study

2020 ◽  
Vol 1 (1) ◽  
pp. 012-017
Author(s):  
Najib Zouhair ◽  
Anass Chaouki ◽  
Amine M’khatri ◽  
Youssef Oukessou ◽  
Sami Rouadi ◽  
...  
Keyword(s):  
Middle Ear ◽  
Operating Time ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Invasive Approach ◽  
Intraoperative Bleeding ◽  
Advantages And Disadvantages ◽  
Early Return ◽  
The Mean ◽  
Endoscopic Tympanoplasty

Tympanoplasty is one of the most performed procedures in ENT. The aggressiveness of its microscopic approach has led otologists to adopt the endoscopic approach as a less invasive alternative. The purpose of this work is to appreciate the advantages and disadvantages of this surgical technique. We conducted a prospective descriptive cross-sectional study on 20 interventions within the ENT department of August the 20th 1953 Hospital of Casablanca from April 2019 to June 2019. The average age of operated patients was 36.3 years. Perforations were unilateral in (71%) of the cases with a predominance of the anterior (29%) and subtotal (36%) locations. The tympanoplasties were performed by 3 different senior otologic surgeons, and were left in (57%). The mean operating time was (59.5 min) and the mean anesthesia duration was 75.1 min. Intraoperative vision allowed us to fully visualize the margins of all perforations (100%) and anatomical structures of the middle ear in almost all interventions. The first procedures carried out were filled with difficulties whose management of intraoperative bleeding was the main one in (42.8%) of the cases. (57%) procedures were described as easy. No complication was detected intraoperatively or immediately postoperatively. Endoscopic tympanoplasty has several advantages, including: Minimally invasive approach to the middle ear; panoramic perioperative vision; Gain of operating time; decrease in the duration of anesthesia; Valuable educational tool; postoperative comfort; Decrease in hospital stay and early return to daily activities; Better aesthetic rendering; cost and transportability. However, we also note a number of disadvantages of endoscopic tympanoplasty, particularly: performing the procedure with one hand; difficulty passing through the EAC; 2D vision that alters the perception of depth; management of intraoperative bleeding; fogging; learning curve.

scholarly journals Hospital mortality in the surgical service of University Clinics of Lubumbashi in the Democratic Republic of the Congo: retrospective study over 6 months

2021 ◽  
Vol 7 (2) ◽  
pp. 42-46
Author(s):  
Augustin Kibonge Mukakala ◽  
◽  
David Mutombo ◽  
Manix Banza Ilunga ◽  
Michel Manika Muteya ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Operating Time ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Surgical Department ◽  
Republic Of The Congo ◽  
Retrospective Data Collection ◽  
Therapeutic Measures ◽  
The Mean ◽  
The University

Introduction: The study of mortality in a community permits to define the axes of disease prevention and readjust health policies. In a hospital department, such a study allows monitoring and revision of therapeutic measures; these are likely to deteriorate in their implementation over the years, which requires periodic criticism. The aim of our work was to record the frequency of deaths in the surgical department of the university clinic of Lubumbashi, to specify the characteristics of the deceased population as well as the main causes of death. Patients and method: This is a descriptive cross-sectional study with retrospective data collection, examining mortality in the surgical department of the university clinic of Lubumbashi over a six-month period, from January 15, 2020 to July 15, 2020. The data were collected from the hospitalization registers and files of patients in intensive care and from the operating protocol registers, grouped together on a three-fold sheet: epidemiological-clinical, therapeutic and progressive and processed in Word and Excel. We excluded from the study patients whose death was noted on admission to the emergency room. Results: The mortality rate was 18.8%, the mean age was 49.21 ± 21.87 (Extremes: 2-93 years) and the sex ratio M / F 5.14. Emergency was the most common mode of admission in 65.12% of cases (n = 28). 51.16% of death cases (n = 22) occurred postoperatively, while in 41.86% of cases (n = 18) patients had died without being operated. There were no reported comorbidities in 74.42% of the deaths (n = 32), and diabetes mellitus was the most common comorbidity in 16.28% of the cases (n = 7). 80% of the deaths were classified ASA III (n = 20). The initial cause of death was more abdominal and digestive pathologies (emergencies) in 39.53% (n = 17) of the whole series. In our study, patients who had had surgery before death accounted for 58.14% of cases, and 40% of them had been operated on at least once. The abdominal and digestive operations were more reoperated than the others with 9/10 cases, or 90% of re-intervention. The mean operating time was 6.54 ± 3.41 (Extreme: 0 and 9 days), and the mean hospital stay was 8.4 ± 14.5 (Extreme: 0 and 61 days). Conclusion: Our work has shown that the mortality rate found at 18.8% remains high given the university status of our establishment where the patients treated are often carriers of serious pathologies and where the interveners are varied. This forces us to question ourselves, not to make ourselves feel guilty but to draw the attention of general surgery nursing staff to our shortcomings, and to correct them.

scholarly journals Comparison of Emergency Medical Services Duration amid Routine Service for COVID-19 Patients

2021 ◽  
Vol 9 (E) ◽  
pp. 289-292
Author(s):  
Korakot Apiratwarakul ◽  
Takaaki Suzuki ◽  
Ismet Celebi ◽  
Kamonwon Ienghong ◽  
Thanat Tangpaisarn ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Operating Time ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Medical Services ◽  
Cross Sectional ◽  
Routine Service ◽  
Emergency Medical ◽  
Number Of Patients ◽  
The Mean

BACKGROUND: Concerning the COVID-19 outbreak in Thailand, the number of patients has been increasing. Emergency medical services (EMS) operating duration differs from normal services due to equipment preparation, number of personnel, and on-board ambulance procedures. Notably, there have been no studies examining EMS duration regarding COVID-19 patients. AIM: The aim of this study was to compare the EMS time for COVID-19 patients and routine services. METHODS: This cross-sectional study was conducted in a tertiary university hospital in Khon Kaen, Thailand. Information gathering was carried out by employing the Srinagarind Hospital EMS database throughout January 1, 2020, and February 10, 2021. RESULTS: A total of 2420 EMS operations were examined, of which five tested positive for COVID-19 (0.21%). The mean age of the COVID-19 patients was 35.6 ± 7.2 years, with the activation interval for COVID-19 and routine services at 64.20 ± 10.14 and 1.42 ± 0.42 min, respectively (p < 0.001). The on-scene time for COVID-19 and routine services was 3.20 ± 0.44 and 5.20 ± 2.20 min, respectively. CONCLUSIONS: EMS operating time amid the activation interval for COVID-19 patients was significantly longer than in the normal group. However, on-scene time for COVID-19 patients was less time than in normal operations.

Brief Overview and Experience of Visual Evoked Potential of First 67 cases at Referral Neuroscience Hospital in Bangladesh

2020 ◽  
Vol 6 (2) ◽  
pp. 74-77
Author(s):  
Mohammad Enayet Hussain ◽  
Bithi Debnath ◽  
AFM Al Masum Khan ◽  
Md Ferdous Mian ◽  
Md Nahidul Islam ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Optic Neuritis ◽  
Clinical Diagnosis ◽  
Optic Neuropathy ◽  
Cross Sectional Study ◽  
P Value ◽  
Pattern Reversal ◽  
Cross Sectional ◽  
The Mean ◽  
Visual Evoked

Background: The visual evoked potentials (VEP) is a valuable tool to document occult lesions of the central visual channels especially within the optic nerve. Objectives: The purpose of the present study was to observe the findings of first few cases of VEP done in the neurophysiology department of the National Institute of Neurosciences (NINS), Dhaka, Bangladesh. Methodology: This cross-sectional study was conducted in the Department of Neurophysiology at the National Institute of Neurosciences and Hospital, Dhaka, Bangladesh from September 2017 to March 2020. All patients referred to the Neurophysiology Department of NINS for VEP were included. Pattern reversal VEPs were done using standard protocol set by International Federation of Clinical Neurophysiology (IFCN). Results: The mean age of the study population was 30.70 (±12.11) years (6-68 years) with 31 (46.3%) male and 36 (53.7%) female patients. The mean duration of illness was 8.71 (±1.78) months (3 days- 120 months). Most common presenting symptom was blurring of vision (37.3%) and dimness of vision (32.8%). Patterned VEP revealed mixed type (both demyelinating and axonal) of abnormality in most cases [29(43.35)]. The most common clinical diagnosis was multiple sclerosis (29.85%) and optic neuropathy (26.87%). In the clinically suspected cases of multiple sclerosis, optic neuropathy and optic neuritis most of the cases of VEP were abnormal and the p value is 0.04 in optic neuropathy and optic neuritis. Conclusion: The commonest presentation of the patients in this series were blurring of vision and dimness of vision. The most common clinical diagnosis for which VEP was asked for, was optic neuritis and multiple sclerosis. Most abnormalities were of mixed pattern (demyelinating and axonal). Journal of National Institute of Neurosciences Bangladesh, 2020;6(2): 74-77

Sonographic Assessment of Amniotic Fluid Volume using Single Deepest Pocket (SDP) among Igbo Women with Uncomplicated Singleton Pregnancies.

2019 ◽  
Vol 2 (1) ◽  
pp. 1-18
Author(s):  
Chijioke Okeudo ◽  
B.U. Ezem
Keyword(s):  
Amniotic Fluid ◽  
Gestational Age ◽  
Cross Sectional Study ◽  
Fluid Volume ◽  
Singleton Pregnancy ◽  
Cross Sectional ◽  
South Eastern ◽  
Amniotic Fluid Volume ◽  
The Mean ◽  
Singleton Pregnancies

Background: The amniotic fluid is fundamental for proper fetal development and growth. Ultrasound visualization of the amniotic fluid permits both subjective and objective estimates of the amniotic fluid. Objective: The objective of this study was to determine the reference values of normal single deepest pocket (SDP) – upper and lower limits, mean SDP and variation of the SDP with gestational age among Igbo women of South-Eastern Nigeria extraction carrying uncomplicated singleton pregnancy. Methodology: This was a prospective cross sectional study involving 400 women carrying uncomplicated singleton pregnancies and who were sure of the date of the first day of their last menstrual period. The single deepest pocket / maximum vertical pool were determined once at presentation at the hospital.. The study was conducted from January 1st to December 31st 2015. The second author carried out all the scanning. The SDP was obtained. Results: The womens’ mean and median ages were the same at 28 years. The gestational age range of the pregnancies was 14-41 weeks. The mean SDP was 5.8cm, while the 5th and 95th percentiles were 3.3cm and 8.5cm respectively. There was no difference in the mean SDP in both term and preterm. There was irregular but continuous rise of mean SDP to a peak of 6.8cm at gestational age of 39 weeks. In conclusion, the participants had a mean SDP of 5.8cm. There was also a positive correlation between SDP and Gestational age. We therefore recommend a longitudinal study to assess perinatal outcome and abnormal amniotic fluid volume among Igbo women of South-Eastern Nigeria. Key words: Single Deepest Pocket, Uncomplicated Singleton Pregnancy, Igbo Women.

Comparison of Heffner Criteria and Light Criteria in Differentiating Exudative and Transudative Pleural Effusion

2020 ◽  
Vol 22 (3) ◽  
pp. 141-145
Author(s):  
Krishna Chandra Devkota ◽  
S Hamal ◽  
PP Panta
Keyword(s):  
Pleural Effusion ◽  
Cross Sectional Study ◽  
Pleural Space ◽  
Sectional Study ◽  
Inclusion Criteria ◽  
Cross Sectional ◽  
Medical College ◽  
The Common ◽  
The Mean ◽  
Exudative Pleural Effusion

Pleural effusion is present when there is >15ml of fluid is accumulated in the pleural space. It can be divided into two types; exudative and transudative pleural effusion. Tuberculosis and parapneumonic effusion are the common cause of exudative pleural effusion whereas heart failure accounts for most of the cases of transudative pleural effusion. This study was a hospital based cross sectional study performed at Nepal Medical College during the period of January 2016-December 2016. A total of 50 patients who fulfilled the inclusion criteria were enrolled. Pleural effusion was confirmed by clinical examination and radiology. After confirmation of pleural effusion, pleural fluid was aspirated and was analysed for protein, LDH, cholesterol. The Heffner criteria was compared with Light criteria to classify exudative or transudative pleural effusion. Among 50 patients, 30 were male and 20 were female. The mean age of patient was 45.4±21.85 years. The sensitivity and specificity of using Light criteria to detect the two type of pleural effusion was 100% and 90.9%, whereas using Heffner criteria was 94.87%, 100% respectively(P<0.01). There are variety of causes for development of pleural effusion and no one criteria is definite to differentiate between exudative or transudative effusion. In this study Light criteria was more sensitive whereas Heffner criteria was more specific to classify exudative pleural effusion. Hence a combination of criteria might be useful in case where there is difficulty to identify the cause of pleural effusion.

scholarly journals Pancreas-Preserving Total Duodenectomy: A Systematic Review

2021 ◽  
pp. 1-12
Author(s):  
Miguel Cantalejo-Díaz ◽  
José Manuel Ramia-Ángel ◽  
Ana Palomares-Cano ◽  
Mario Serradilla-Martín
Keyword(s):  
Systematic Review ◽  
Postoperative Morbidity ◽  
Operating Time ◽  
Pancreatic Head ◽  
Cochrane Library ◽  
Morbidity Rate ◽  
Intraoperative Bleeding ◽  
Risks And Benefits ◽  
Duodenal Lesions ◽  
The Mean

<b><i>Background:</i></b> The management of the pancreas in patients with duodenal trauma or duodenal tumors remains a controversial issue. Pancreas-preserving total duodenectomy (PPTD) requires a meticulous surgical technique. The most common indication is familial duodenal adenomatous polyposis (FAP). The aims of this study are to carry out a systematic review of the literature on the indications for PPTD and to highlight the risks and benefits compared with other more aggressive procedures. <b><i>Summary:</i></b> A systematic literature review was performed following PRISMA recommendations of studies published in PubMed, Embase, and Cochrane library until May 2019. Thirty articles describing 211 patients were chosen. The mean age was 48 years. The surgical indication in 75% of patients was FAP. The mean operating time was 329 min and mean intraoperative bleeding 412 mL. Postoperative morbidity rate was 49.7% (76% Clavien-Dindo &#x3c;IIIa), and mortality rate was 1.4%. The mean hospital stay was 22 days. Overall survival at 1–3–5 years was &#x3e;97.8%. <b><i>Key Messages:</i></b> PPTD is indicated for patients with benign and premalignant duodenal lesions without involvement of the pancreatic head. It is a feasible procedure offering an alternative to other more aggressive procedures in selected patients. Mortality is below 1.5%.

scholarly journals High Adherence to the Mediterranean Diet Is Associated with a Reduced Risk of Obesity among Adults in Gulf Countries

Nutrients ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 995
Author(s):  
Israa M. Shatwan ◽  
Eiman A. Alhinai ◽  
Balqees Alawadhi ◽  
Shelini Surendran ◽  
Najlaa M. Aljefree ◽  
...  
Keyword(s):  
Mediterranean Diet ◽  
Total Sample ◽  
Cross Sectional Study ◽  
Inverse Association ◽  
Protective Effects ◽  
Hip Circumference ◽  
Cross Sectional ◽  
Gulf Countries ◽  
The Mean ◽  
The Mediterranean

The Mediterranean diet (MedDiet) is considered as a good example of a healthy dietary pattern that has protective effects on obesity. The aim of the present study was to assess the adherence of adults from three Gulf countries (Saudi Arabia, Oman, and Kuwait) to the MedDiet and its association with obesity risk. A cross-sectional study was conducted on 961 men and women (75.7%) aged 20–55 years old. Waist circumference (WC), and hip circumference (HC) were measured waist/hip ratio (WHR) and body mass index (BMI) were calculated. A validated 14-item Questionnaire was used to measure adherence to MedDiet. The mean of the adherence to MedDiet score was 5.9 ± 2.03 for the total sample. An inverse association was observed between the adherence to MedDiet and BMI after adjusting for potential confounders (p = 0.0003 in total participants, and p = 0.001 in women only). A protective effect was seen with a higher adherence to the MedDiet on HC, suggesting that a greater adherence to the MedDiet was associated with a decreased HC (p = 0.04 in total participants, and p = 0.01 in women only). In conclusion, low adherence to the MedDiet among participants from three gulf countries was associated with increased obesity indicators, BMI, and HC.

Altered retinal oxygen metabolism in patients with combined ocular and central nervous system sarcoidosis

Rheumatology ◽  
2020 ◽  
Author(s):  
Astrid Kindt ◽  
Keld-Erik Byg ◽  
Jimmi Wied ◽  
Torkell Ellingsen ◽  
Jesper Rømhild Davidsen ◽  
...  
Keyword(s):  
Oxygen Metabolism ◽  
Cross Sectional Study ◽  
Screening Methods ◽  
Cross Sectional ◽  
Corrected Visual Acuity ◽  
Multi Linear Regression ◽  
The Mean ◽  
Arteriovenous Difference ◽  
Retinal Arteriolar ◽  
Retinal Oximetry

Abstract Objective To evaluate retinal oxygen metabolism by retinal oximetry for ocular and CNS diseases in a cross-sectional study of sarcoidosis. Methods Overall 201 eyes from 103 biopsy-verified sarcoidosis patients were included and divided into four groups depending on the organ affection: (i) sarcoidosis without ocular or CNS affection, (ii) ocular sarcoidosis, (iii) CNS sarcoidosis, and (iv) combined ocular and CNS sarcoidosis. Retinal oximetry was obtained and analysed, with the mean retinal arteriolar and venular saturation as well as arteriovenous difference as principal outcomes. Comparison between groups was done in a multi linear regression model adjusted for age, sex, duration of sarcoidosis, best corrected visual acuity and retinal oximetry quality. Results Mean (s.d.) age was 50.5 (13.4) (95% CI: 47.9, 53.1) years and 52.2% were males. Eyes of the combined Ocular/CNS group had a higher retinal arteriovenous difference than eyes of the Non-ocular/no-CNS group (42.1% vs 37.7%, P = 0.012) but did not differ between other groups. Eyes in the four groups (Non-ocular/no-CNS, Ocular, CNS and Ocular/CNS) did not differ according to retinal arterial (94.5%, 93.5%, 93.5% and 94.5%, respectively) or venular (57.5%, 56.4%, 55.0% and 52.5%, respectively) oxygen saturation. Conclusions The results of this study suggest that eyes of sarcoidosis patients with combined ocular and CNS affection have an altered oxygen metabolism indicating a subclinical eye affection that is not recognized by conventional screening methods.

Effect of Medialization of the Trochlear Groove and Lateralization of the Tibial Tubercle on TT-TG Distance: A Cross-sectional Study of Dysplastic and Nondysplastic Knees

2021 ◽  
pp. 036354652098781
Author(s):  
Mathias Paiva ◽  
Lars Blønd ◽  
Per Hölmich ◽  
Kristoffer Weisskirchner Barfod
Keyword(s):  
Trochlear Dysplasia ◽  
Cross Sectional Study ◽  
Magnetic Resonance Images ◽  
Tibial Tubercle ◽  
Control Group ◽  
Trochlear Groove ◽  
Sectional Study ◽  
Cross Sectional ◽  
Mean Values ◽  
The Mean

Background: Tibial tubercle–trochlear groove (TT-TG) distance is often used as a measure of lateralization of the TT and is important for surgical planning. Purpose: To investigate if increased TT-TG distance measured on axial magnetic resonance images is due to lateralization of the TT or medialization of the TG. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 84 knees (28 normal [NK], 28 with trochlear dysplasia [TD], and 28 with patellar dislocation without TD [PD]) were examined. The medial border of the posterior cruciate ligament (PCL) was chosen as the central anatomic landmark. The distance from the TT to PCL (TT-PCL) was measured to examine the lateralization of the TT. The distance from the TG to the PCL (TG-PCL) was measured to examine the medialization of the TG. Between-group differences were investigated by use of 1-way analysis of variance. Results: The mean values for TT-TG distance were 8.7 ± 3.6 mm for NK, 12.1 ± 6.0 mm for PD, and 16.7 ± 4.3 mm in the TD group ( P < .01). The mean values for TT-PCL distance were 18.5 ± 3.6 mm for NK, 18.5 ± 4.5 mm for PD, and 21.2 ± 4.2 mm in the TD group ( P = .03). The mean values for TG-PCL distance were 9.6 ± 3.0 mm for NK, 7.1 ± 3.4 mm for PD, and 5.1 ± 3.3 mm in the dysplastic group ( P < .01). Conclusion: The present results indicate that increased TT-TG distance is due to medialization of the TG and not lateralization of the TT. Knees with TD had increased TT-TG distance compared with the knees of the control group and the knees with PD. The TT-PCL distance did not differ significantly between groups, whereas the TG-PCL distance declined with increased TT-TG.

scholarly journals POS0548 OPTIMAL ASSESSMENT OF THE RHEUMATOID ARTHRITIS ANKLE AND HINDFOOT: A COMPARATIVE STUDY BETWEEN CLINICAL EXAMINATION AND ULTRASONOGRAPHY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 508.2-509
Author(s):  
K. Maatallah ◽  
H. Boussaa ◽  
H. Riahi ◽  
H. Ferjani ◽  
M. Habechi ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Examination ◽  
Demographic Data ◽  
Power Doppler ◽  
Cross Sectional Study ◽  
P Value ◽  
Cross Sectional ◽  
Therapeutic Decisions ◽  
The Mean ◽  
Foot Disease

Background:Foot disease is a common problem in rheumatoid arthritis (RA). Therapeutic decisions are often based on clinical examination (CE) alone, which can be adversely affected by factors such as deformity, obesity, and peripheral edema. Ultrasonography (US) has previously been shown to be more sensitive than CE for detecting synovitis and tenosynovitis in RA forefeet, but few data exist for the hindfoot and ankle.Objectives:The aim of this study was to compare CE and US for the detection of hindfoot and ankle synovitis and tenosynovitis in patients with established RA.Methods:We conducted a cross-sectional study including patients with RA (ACR/EULAR 2010). Demographic data and disease parameters were collected. CE was performed by a rheumatologist for the presence or absence of tenderness, swelling, and mobility restriction of both ankles. The following tendons were examined for tenosynovitis: tibialis anterior (TA) and posterior (TP), fibularis longus (FL), and brevis (FB) (assessed together). In a second time, US examination of the tibiotalar, talonavicular, and subtalar joints and the same tendons as CE was performed by a blinded radiologist experienced in musculoskeletal imaging using a Philips HD11 device with a high-frequency linear transducer. The presence or absence of synovitis and tenosynovitis was recorded, and the composite synovitis score (power doppler / grayscale ultrasound (PDUS)) was measured for each joint. The US score of each patient was defined by the sum of the composite scores of the joints studied (0-30). A p-value <0.05 was considered significant.Results:Sixty-two feet were examined in 31 RA patients (25 women and six men) with a mean age of 54.8±10.8 years old [32-70]. The mean disease duration was 8.5±7.2 years [1-37]. Rheumatoid Factor (RF) and Anti-Citrullinated Peptides Antibodies (ACPA) were positive in 61.3% and 83.8% of cases. The mean DAS28 ESR was 3.8±1.5 [0.6-7].Clinical examination of ankles revealed tenderness in 57.4% of cases, swelling in 38.8% of cases, and restriction in the range of motion in 11.1% of cases. TA tenosynovitis was noted in 14.8% of cases, TP tenosynovitis in 22.2% of cases, and FL and FB tenosynovitis in 31.5% of cases.US showed tibiotalar synovitis in 59.3% of cases, talonavicular synovitis in 64.8% of cases, and subtalar synovitis in 46.3% of cases. TA tenosynovitis was noted in 5.6% of cases, TP tenosynovitis in 22.2% of cases, and FB and FL tenosynovitis in 25% and 11.1% of cases respectively.An association was found between clinical tenderness and US synovitis of the tibiotalar joint (p=0.013) and the talonavicular joint (p=0.027). No association was noted between clinical swelling and US synovitis in these joints.No association was noted between clinical and US tenosynovitis of TA (p=0.279), TP (p=0.436), FB (p=0.495) and FL (p=0.315).Conclusion:Clinical examination of RA ankles may be challenging and needs to be coupled with US, which is more sensitive and accurate in the detection of synovitis and tenosynovitis.Disclosure of Interests:None declared

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