Occurrence and risk factors of uveitis in juvenile psoriatic arthritis: Data from a population-based nationwide study in Germany

Objective Data on uveitis in juvenile psoriatic arthritis (JPsA), a category of juvenile idiopathic arthritis (JIA), are scarce. We describe prevalence and risk factors for JPsA-associated uveitis (JPsA-U). Methods Cross-sectional data from the National Pediatric Rheumatological Database (from 2002 to 2014) were used to characterize JPsA-U and assess risk factors for uveitis development. Results Uveitis developed in 6.6% of 1862 JPsA patients. JPsA-U patients were more frequently female (73.0 vs 62.9%, p=0.031), ANA positive (60.3 vs 37.0%, p<0.001), younger at JPsA onset (5.3 ± 4.1 vs 9.3 ± 4.4 years, p<0.001), and received DMARD (disease modifying antirheumatic drug) treatment significantly more frequently than JPsA patients without uveitis. On multivariable analysis of a subgroup of 655 patients, mean cJADAS during study documentation was significantly associated with uveitis development. Children with early onset of JPsA were significantly more frequently ANA positive (48.4% vs 35.7% for those younger than 5 years at JPsA onset versus those aged 5 years and older, p<0.001), less often affected by skin disease (55.3% vs 61.0%, p=0.032), but more frequently by uveitis (17.3% vs 3.8%, p<0.001), and required DMARD treatment more frequently (52.9% vs 43.8%, p<0.001). Conclusion The characteristics of JPsA patients developing uveitis are similar to those of patients with uveitis in other JIA categories, such as oligoarticular JIA. Especially those children with early onset of JPsA seem to be at a higher risk for ocular involvement. Our data support the notion of a major clinical difference between those patients with early versus late onset of JPsA.

Do Clinical Outcomes and Failure Rates Differ in Patients With Combined ACL and Grade 2 MCL Tears Versus Isolated ACL Tears?: A Prospective Study With 14-Year Follow-up

Background: A combined injury to the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) is a common injury pattern encountered during clinical practice. Recent systematic reviews have found no consensus on the optimal method of managing this combined ligament injury pattern, and no long-term studies with modern techniques are available in the literature. Purpose: To compare 2 groups of patients who underwent isolated ACL reconstruction in terms of failures and clinical scores at long-term follow-up. In the first group were patients with isolated ACL tears (ACL group), while the second was composed of patients with combined ACL and MCL grade 2 tears (ACL + MCL group). Study Design: Cohort study; Level of evidence, 3. Methods: A total of 57 patients (37 in the ACL group and 20 in the ACL + MCL group) underwent isolated ACL reconstruction with a double-bundle technique between January and December 2005. Patients were contacted for scores on the International Knee Documentation Committee subjective form, Western Ontario and McMaster Universities Osteoarthritis Index, and Tegner activity scale as well as data regarding ipsilateral or contralateral revision ACL surgery. A 2-way analysis of variance for repeated measures was used to statistically assess the differences between the groups. Results: Overall, 49 patients (86%) completed the survey and were therefore included in the study. The minimum follow-up was 14.6 years (range, 14.1-15.2 years). There was a significant reduction in both groups of all the outcome scores between the intermediate and final-follow-up. The number of failures was 3 of 31 (9.7%) in the ACL group and 1 of 18 (5.5%) in the ACL + MCL group; this difference was not significant. Moreover, there were no clinical differences between the groups in terms of graft failures, contralateral lesions, and clinical scores. Conclusion: At 14-year follow-up, no clinical difference or increased failure rate was observed between the study groups, suggesting that isolated ACL reconstruction could represent an appropriate treatment for a combined ACL and MCL grade 2 lesion.

MYOFASCIAL RELEASE AND SUPERFICIAL BACKLINE STRETCHING ON HAMSTRING STRAIN IN CRICKET PLAYERS: AN INTERVENTIONAL STUDY

Background: Hamstring Strain is common among athletes which lead to development of injury. Superficial Backline stretching for improving range of motion and flexibility. Using Tennis ball is a form of self-myofascial release results in increasing range of motion. Literature lacks studies done on self- myofascial release and superficial backline stretching. Hence my intention towards this study in comparison to find out the effect of Self Myofascial Release using tennis ball and superficial backline stretching on hamstring strain in cricket players. Methodology: A total of 24 subjects who were between the age group of 15 -19 years were conveniently allocated based on the inclusion criteria. Subjects received self-myofascial release using tennis ball 60 sec with 3-4 repetitions and 1 min interval of rest between sessions and superficial backline stretching with different poses for 2-3 repetitions and then compared FMS score of all subjects pre and post intervention after giving the superficial backline stretches and myofascial release to all the subjects. Outcome measure: Functional movement screen (FMS) Results: The result shows that there is a significant difference in pre and post Score of FMS, pre-FMS score is 15.9167±2.60295 and post score increased to 19.2500±1.59483which shows thatthere is statistical and clinical difference between the pre and post intervention. Functional movement is measured as the primary outcome measure.There is an average improvement of 3.333 with t value 12.487 and p <0.05. Conclusion: The aim of the study was to compare and find out the effect of Self Myofascial Release using tennis ball and superficial backline stretching on hamstring strain in cricket players., the result showed that there is statistically significant self-myofascial release using tennis ball and superficial backline stretching.

Traumatic Head Injury and the Diagnosis of Abuse: A Cluster Analysis

OBJECTIVES: Data guiding abusive head trauma (AHT) diagnosis rest on case-control studies that have been criticized for circularity. We wished to sort children with neurologic injury using mathematical algorithms, without reference to physicians’ diagnoses or predetermined diagnostic criteria, and to compare the results to existing AHT data, physicians’ diagnoses, and a proposed triad of findings. METHODS: Unsupervised cluster analysis of an existing data set regarding 500 young patients with acute head injury hospitalized for intensive care. Three cluster algorithms were used to sort (partition) patients into subpopulations (clusters) on the basis of 32 reliable (κ &gt; 0.6) clinical and radiologic variables. P values and odds ratios (ORs) identified variables most predictive of partitioning. RESULTS: The full cohort partitioned into 2 clusters. Variables substantially (P &lt; .001 and OR &gt; 10 in all 3 cluster algorithms) more prevalent in cluster 1 were imaging indications of brain hypoxemia, ischemia, and/or swelling; acute encephalopathy, particularly when lasting &gt;24 hours; respiratory compromise; subdural hemorrhage or fluid collection; and ophthalmologist-confirmed retinoschisis. Variables substantially (P &lt; .001 and OR &lt; 0.10 in any cluster algorithm) more prevalent in cluster 2 were linear parietal skull fracture and epidural hematoma. Postpartitioning analysis revealed that cluster 1 had a high prevalence of physician-diagnosed abuse. CONCLUSIONS: Three cluster algorithms partitioned the population into 2 clusters without reference to predetermined diagnostic criteria or clinical opinion about the nature of AHT. Clinical difference between clusters replicated differences previously described in comparisons of AHT with non-AHT. Algorithmic partition was predictive of physician diagnosis and of the triad of findings heavily discussed in AHT literature.

Changes and thresholds in the Forgotten Joint Score after total hip arthroplasty

Aims The aim of this study was to identify the minimal clinically important difference (MCID), minimal important change (MIC), minimal detectable change (MDC), and patient-acceptable symptom state (PASS) in the Forgotten Joint Score (FJS) according to patient satisfaction six months following total hip arthroplasty (THA) in a UK population. Methods During a one-year period, 461 patients underwent a primary THA and completed preoperative and six-month FJS, with a mean age of 67.2 years (22 to 93). At six months, patient satisfaction was recorded as very satisfied, satisfied, neutral, dissatisfied, or very dissatisfied. The difference between patients recording neutral (n = 31) and satisfied (n = 101) was used to define the MCID. MIC for a cohort was defined as the change in the FJS for those patients declaring their outcome as satisfied, whereas receiver operating characteristic curve analysis was used to determine the MIC for an individual and the PASS. Distribution-based methodology was used to calculate the MDC. Results Using satisfaction as the anchor, the MCID for the FJS was 8.1 (95% confidence interval (CI) 3.7 to 15.9; p = 0.040), which was affirmed when adjusting for confounding. The MIC for the FJS for a cohort of patients was 17.7 (95% CI 13.7 to 21.7) and for an individual patient was 18. The MDC90 for the FJS was eight, meaning that 90% of patients scoring more than this will have experienced a real change that is beyond measurement error. The PASS threshold for the FJS was defined as 29. Conclusion The MCID and MIC can be used respectively to assess whether there is a clinical difference between two groups, or whether a cohort or patient has had a meaningful change in their FJS. Both values were greater than measurement error (MDC90), suggesting a real change. The PASS threshold for the postoperative FJS can be used as a marker of achieving patient satisfaction following THA. Cite this article: Bone Joint J 2021;103-B(12):1759–1765.

Combined Artificial Intelligence Approaches Analyzing 1000 Conservative Patients with Back Pain—A Methodological Pathway to Predicting Treatment Efficacy and Diagnostic Groups

Patients with back pain are common and present a challenge in everyday medical practice due to the multitude of possible causes and the individual effects of treatments. Predicting causes and therapy efficien cy with the help of artificial intelligence could improve and simplify the treatment. In an exemplary collective of 1000 conservatively treated back pain patients, it was investigated whether the prediction of therapy efficiency and the underlying diagnosis is possible by combining different artificial intelligence approaches. For this purpose, supervised and unsupervised artificial intelligence methods were analyzed and a methodology for combining the predictions was developed. Supervised AI is suitable for predicting therapy efficiency at the borderline of minimal clinical difference. Non-supervised AI can show patterns in the dataset. We can show that the identification of the underlying diagnostic groups only becomes possible through a combination of different AI approaches and the baseline data. The presented methodology for the combined application of artificial intelligence algorithms shows a transferable path to establish correlations in heterogeneous data sets when individual AI approaches only provide weak results.

Long-term functional results of transvaginal anal sphincter repair for faecal incontinence; a retrospective cohort study.

Objective We report our experience with a transvaginal approach with overlapping AS repair. The aim of this study was to evaluate long term functional outcomes. Design Retrospective Cohort study. Setting and Population Women who had undergone AS surgery for anal incontinence from July 2005 to July 2020. were included. The patients included attended the Mercy Hospital Perineal clinic a multidisciplinary team of urogynecologists and colorectal surgeons. Private patients from the surgeons in Perineal clinic were also included. Methods Overall 107 women were included in the study with a median follow up of 57.5 months. Main Outcome Measure We analysed outcomes by comparing patients St marks score difference before and after surgery. Meaningful clinical difference (MID) was set at 5 points as per previous validation studies, complications and patient demographics were recorded along with a question if they would recommend this treatment to a friend. Results An improvement exceeding the minimal clinical difference (MID) was seen in 69.3% of women. With a marked improvement in 46.5% of patients. Furthermore 70% of our patients would recommend the procedure to a friend, if they were in a similar situation. Wound infection or perineal breakdown occurred in 45% of women but did not significantly impact on outcomes. Conclusion Transvaginal AS repair is associated with significant improvements in patients’ St. Marks score. Our data shows that the long-term success rate of transvaginal AS repair may be better than previously reported in the literature using a transvaginal approach. Funding This study received no funding or sponsorship

A comparative study of Fractional co2 laser combined with topical methotrexate versus Fractional co2 laser combined with topical [Calcipotriol + Betamethasone] in the treatment of nail psoriasis

Background Nail psoriasis is a distressing clinical condition as it is known that psoriasis on visible areas of the skin, such as the face, hands and nails, may have a substantial negative impact on physical, psychological, and social dimensions of quality of life. The additional negative consequences of nail involvement in psoriasis are pain, inability to grasp small objects, tie shoe laces or button clothes, and cause an altered sense of fine touch. Objective To evaluate and compare the efficacy, safety and side effects of co2 laser combined with topical methotrexate in one side and topical (calcipotriol +betamethasone) in the other side of the patient for the treatment of nail psoriasis. Patients and Methods This comparative pilot study included 20 patients with nail psoriasis. They were recruited from the dermatology out-patient clinic of Ain–Shams University Hospitals, during the period from March 2019 till October 2019. The study was approved by Research Ethical Committee of Ain Shams University (FMASU M S 71/2019) and fulfilled all the ethical aspects required for a human research. Results Our study revealed that both medications showed marked statistical and clinical improvement of the nail condition in a period of 2 months when applied topically after nail exposure to fractional co2 laser which facilitated the delivery of both medications through the nail plates to the site of the psoriasis inflammation in therapeutic concentrations by creating pores through the nails. There was no statistical or clinical difference between both medications regarding the improvement of the NAPSI scores or the level of patient satisfaction. However, there were some nail symptoms that didn’t show any improvement as (sub-ungual hyperkeratosis and nail ridging). Conclusion Our treatment protocol’s side effects based mainly on the action of fractional co2 laser which caused pain and nail bleeding during sessions for some of the patients in each group, while topical methotrexate caused nail yellowish discoloration for the all involved group. However, these side effects lasted for very short time and didn’t have any impact on the level of the patient satisfaction. There was no statistical difference in the level of the patient satisfaction between both groups.

Effect of Powder/Water Ratio Variation on Viscosity, Tear Strength and Detail Reproduction of Dental Alginate Impression Material (In Vitro and Clinical Study)

Background: Alginate impression is a common dental polymeric material, presented as powder to be mixed with water. Aim: 1. To analyze the effect of alginate powder/water ratio variation on viscosity, tear strength and detail reproduction by in vitro tests, and 2. To evaluate this variation’s effect on patients’ impressions. Materials and methods: Two commercial alginate products were mixed in different viscosities. Viscosity was measured by a viscometer. For the tear strength test, V-shaped specimens were used. For detail reproduction, a die with three scribed lines was used. Clinical dental impressions were examined by stereomicroscope. Results: The alginate specimens mixed with a higher powder/water ratio showed a higher viscosity and tear strength compared to those with a lower powder/water ratio. Both alginate mixtures reproduced two scribed lines in a detail reproduction test. On the other hand, no clear clinical difference was detected when examining dental impressions mixed with a different powder/water ratio. Conclusion: Although increasing the powder/water ratio of mixed alginate raised the resultant viscosity and tear strength by an in vitro test, clinically, no clear difference in tearing was detected. Detail reproduction was minimally affected by the variation in powder/water ratio.