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Background: Internal derangement (ID) is the most common cause for TMDs. Various invasive, minimally invasive, andnon-invasive treatment modalities have been attempted. Arthrocentesis as a minimally invasive maneuver either if followedwith various intra-articular medications or not has been attempted to treat ID. Hyaluronic acid (HA) has been used as an intraarticularmedication due to its lubricant effect that improves joint movement and mechanically reduces friction pain. However,the i-PRF had both anti-inflammatory action to reduce the level of the cytokines; aided by the regenerative capacity to the tornand degenerated tissues of the joint including the synovial tissue.Purpose: The current study aimed at comparing both factors.Materials and Methods: Forty TMJs from thirty patients were randomly divided into two equal groups. In group I, arthrocentesiswas followed by intra-articular injection of AH; however, in group II, arthrocentesis was followed i-PRF injection.Results: In general, group II patients recorded better results with respect to clicking, pain, and movement limitation. Superiorresults of i-PRF might be the result of the regenerative capability that not only reduced the existing inflammatory mediators;but also replaced the degenerated cytokines-releasing tissues by healthy synovial fluid-releasing tissues provides endogenoussustained source of HA.Conclusion: Although both treatments are acceptable, i-PRF was a rather recommended treatment.

Introduction :ID management is one of challenges in maxillofacial filed. Almost80% of adult symptomatic patients with TMD have some form of ID (1). Data fromrelated literature has suggested that arthrocentesis may be of some benefit to managesymptoms of TMDs. Such a technique was first introduced for the management ofsudden onset of closed lockAim : This study aimed to evaluate efficacy of simvastatin intra-articular injectionin management of internal derangement (ID) of temporomandibular joint ( TMJ).Patients and methods: 15 patients with internal TMJ derangement were included in thisstudy. All patients were subjected to preoperative clinical examination and preoperativemagnetic resonance imaging (MRI) for the affected joints. The affected joints treatedwith arthrocentesis followed by intra-articular injection of 1ml. simvastatin twice amonth. Clinical follow up were done at 24 hours post- operatively, one week, one monthand six months. Then, after six months MRI was repeated to compare with preoperativeimages. Results: Patients showed better results in comparison to preoperativeparameters at 1 week, 4 and 24 weeks intervals. Patients showed better MRI findings incomparison to preoperative findings where position of the disc was almost returned toits normal anatomical position. Conclusion: Simvastatin intra-articular injection afterarthrocentesis

Remdesivir, a nucleotide analog RNA polymerase inhibitor, which was originally evaluated in clinical trials to thwart the Ebola outbreak in 2014, has shown in vitro efficacy against SARS-CoV-2. Experience on its efficacy and safety in COVID-19 is accumulating. In COVID-19, Remdesivir therapy is given intravenously for 5 to 10 days and is frequently accompanied by transient, reversible mild-to-moderate elevations in serum aminotransferase levels but has been only rarely linked to instances of clinically apparent liver injury as a drug-induced liver injury (DILI). It may be caused by direct toxicity possibly due to inhibition of mitochondrial RNA polymerase. Here, we have discussed two cases where liver enzyme levels increased dramatically on the day next after initiating Remdesivir. Case one and two showed grade 4 and grade 3 hepatotoxicity respectively. In both cases, a positive de-challenge was observed and concomitant drugs were not considered to be confounders. Hence, Remdesivir has a causal relationship with the occurrence of this adverse drug reaction.

The aim of this clinical study was to evaluate the level of Interleukine-6 (IL-6), pre and post arthrocentesis to validate it as a biomarker in the Internal Derangement (ID) of TMJ. This study included 30 patients (20 females and 10 males) of Temporo-Mandibular Dysfunction (TMD) with Disc displacement without reduction (DDwoR) Wilkes stage III, who were refractory to conservative management. Arthrocentesis was performed as a therapeutic modality. Synovial fluid aspirates were obtained prior to arthrocentesis and post arthrocentesis with 300 ml of Ringer Lactate solution into the superior joint compartment for the assessment of level of IL-6. The clinical parameters used for correlating the level of IL-6 were degree of pain (VAS I), chewing ability (VAS II), Maximal Mouth Opening (MMO) in both pre and post op phase with the follow-up period of 01 day, 01 week, 01 month, 03 month and 06 month and the results were compared. ELISA was performed to analyze the levels of IL-6 in the aspirates. The clinical parameters and the level of IL-6 were recorded and analyzed statistically. The study showed ID of TMJ (Wilkes stage III) s are more prevalent in females especially in the fourth decades of life with the mean age of 38.4 years. The post operative assessment in terms of pain, maximum mouth opening, lateral movements of the mandible and the levels of IL-6 were found to be statistically significant with a P value

The purpose of this study was to (1) report on the incidence of concurrent surgical pathology at the time of adolescent ACL reconstruction, (2) evaluate patient risk factors for concurrent pathology, and (3) measure the effect of BMI on operating room (OR) time. A retrospective analysis of the NSQIP database for the years 2005–2017 was conducted. Nine-hundred and seventeen patients 18 years of age and younger who underwent ACL reconstruction (ACLR) were identified using CPT code 29888 and patients undergoing surgery for multi-ligamentous knee injuries were excluded. The mean patient age was 17.6 years (range 14–18, standard deviation 0.52) and consisted of 546 males (59.5%) and 371 females (40.5%). Logistic regression was used to assess the relationship between BMI and additional CPT codes for internal derangement at the time of surgery. Internal derangement was defined as any procedure for the treatment of a meniscal tear, chondral lesion, or loose body removal. Linear regression analysis was then performed to evaluate the effect of BMI on operative time. 43.7% of patients undergoing ACLR required an associated procedure for internal derangement. Additionally, the risk of requiring additional procedures for internal derangement increased by 3.1% per BMI point. BMI was also predictive of operative time, independent of the number of additional procedures. Specifically, the operative time increased by nearly one minute for every point increase in BMI (58.0 s). Adolescent patients with an elevated BMI were much more likely to require additional surgical procedures for internal derangement at the time of ACL reconstruction. Additionally, BMI was a significant predictor for longer operative times. Level III.

Arthrocentesis is a simple minimally invasive procedure with less risk of complications and significant benefits in patients with internal derangement of temporomandibular joint. Here we report a study on four patients to evaluate the efficacy of arthrocentesis in the treatment of internal derangement of temporomandibular joint.

Introduction: Internal derangements of TMJ were nonsurgical treated in initial stages with medications, physiotherapy and occlusal splints. Intra articular injection of corticosteroids alone or after arthrocentesis provides long-term palliative effects on clinical signs and subjective symptoms of TMJ pain. Aim: The study was done to compare between hyaluronic acid and dextrose prolotherapy in management of temporomandibular joint internal derangement. Patients and methods: The present study included 30 adult patients suffering from internal derangement of Temporo-mandibular joint were selected from outpatient clinic, oral and maxillofacial surgery department in faculty of dentistry, Suez Canal University as well as October 6 university. Group I: Composed of 15 patients (10 females, 5 males) where hyaluronic acid was injected intra-articular. Group II: Composed of 15 patients (9 females, 6 males) where dextrose prolotherapy was injected (4 times) at 2 weeks, 4 weeks and 6 weeks intervals over a total of 12 weeks. Results: No difference between Group I and II; both showed the highest mean MIO values. Group I and Group II; both showed lower mean of VAS scores after 12 months compared to pre-operative measurement. After 6 months, Group II showed the highest prevalence of deviation followed by Group I. Conclusion: Sodium hyaluronic acid and Prolotherapy is a successful technique to improve maximum inter-incisal opening as well as assisted interincisal opening and improved higher significant changes in pain intensity.

Malaria is a global health issue caused by Plasmodium Falciparum. Purpose: To determine the effect of age and duration of disease on the derangement in hematological parameters among patients with malaria. Study Design: Descriptive, cross-sectional. Methodology: The current project was conducted at department of Department of Hematology, Combined Military Hospital, Multan. Study comprised of 186 subjects suffering from malaria with hematological dearrangements. Blood taken for routine investigations like ICT malaria and CBC to diagnose anemia and low platelet count. Statistical analysis: The collected data was analyzed by using SPSS version 20. Post-stratification chi-square test was used with p-value

The knee is one of the most commonly injured joint. Knee injury is the second most common problem in the musculoskeletal system for which patients consult their general physician. In acute situations, radiographs can be very useful to diagnose or rule out fractures. A second category of patients’ have sub-acute or even chronic symptoms that may be related to trauma, overuse, degeneration, etc. The study population includes all the patients presenting with history of and /or clinical findings suggestive of knee trauma and use MRI for evaluation. The MRI is done on the advice of the referring doctor and no patient is made to undergo MRI knee for the sole purpose of this study. Posterior horn of medial meniscus was observed to be the most commonly injured. Vertical tear of medial meniscus was identified as the most common type of injury.

Purpose: To evaluate the role of magnetic resonance imaging (MRI) in the diagnosis of internal derangement and to assess the complimentary role of MRI and clinical assessment in prognostication. To assess the role of MRI in demonstrating disc displacement and reduction. Methods: A total of 34 patients (28 cases and 6 controls) with clinical features of temporomandibular joint (TMJ) internal derangement underwent a dedicated MRI at our institution. MRI was assessed for disc displacement, morphology, and reduction on open-mouth imaging. For analysis, the patients were divided into those with disc displacement with reduction (WR) and those without reduction (WOR). Clinical and MRI grading of internal derangement were done in all patients and correlated with each other. Prognostication was attempted using the clinical and MRI features, and patients were followed up over a mean period of 6 months. Results: Most of the patients were females (n = 20 71%) in the child-bearing age group (third decade). MRI demonstrated disc displacement in all but two patients in whom disc was not visible. Fourteen (54%) patients were placed in WR group, whereas 10 (38%) were in WOR group. In two (8%) patients, stuck disc was diagnosed. Patients in WR group responded to conservative treatment alone while those in WOR group needed conservative management in some (n = 8 57%) and surgical intervention in others (n = 6 43%). Both patients with stuck disc failed conservative management. Conclusion: MRI is an essential component of TMJ evaluation and helps in diagnosing and staging internal derangement together with disc assessment. Patients with disc displacement WOR and those with higher grades of derangement on MRI including stuck disc require surgical intervention if conservative management fails.

The aim of this study was to present the results of a modification of the arthroscopic anterior myotomy for the treatment of internal derangement (ID) of the temporomandibular joint (TMJ): the minimally invasive arthroscopic anterior myotomy (MIAAM). Fifteen joints with Wilkes stages III-IV ID treated with this technique were studied. Clinical data evaluated were pain (visual analogue scale, VAS) and articular movements (preoperatively and at 1, 3, 6, 9, and 12 months postoperative). The position of the disc at 1 year after surgery was compared with the pre-surgical position, using magnetic resonance imaging (MRI). The mean pain level according to the VAS decreased from of 67.8 pre-surgery to 29.0 at the 12-month follow-up (P 0.001). Functionally, mouth opening increased from a mean 27.8 mm to 36.0 mm (P 0.001). Evaluation of the MRI images showed statistically significant improvements in disc position in both the closed (P = 0.00002) and open-mouth (P = 0.00001) position. The incidence of re-arthroscopy was 13.3% (2/15). This procedure is an effective method for the improvement of joint function and reduction of pain in patients with ID of the TMJ. However, MIAAM is moderately effective in regards to repositioning of the disc.

It is necessary to clarify that temporomandibular joint disorders (TMDs) are one of the most misdiagnosed and mistreated maladies in the medical practice. It is an umbrella term, embracing conditions which involve the temporomandibular joint (TMJ) and related muscles. One of these common irritating disorders is the internal derangement which is used specifically to describe the displacement of the TMJ disc. The treatment can vary according to the severity and chronicity into non-invasive, minimally invasive, and invasive procedures. However, permanent recovery is rarely obtained. This study was established to compare the effectiveness of two minimally invasive procedures: arthrocentesis and glucocorticosteroid (GCS) local single joint injection in the management of internal derangement of the TMJ. Thirty patients aged from 18 to 42 years were included in this study with internal derangement which was confirmed clinically and with a cone beam CT scan. The patients were divided into two groups of 15 patients. Arthrocentesis was performed to one group (group A) by using Shepard’s cannula and lactated Ringer’s solution. Glucocorticosteroid injection was done to the other group (group B) using a 1 ml/40 mg methylprednisolone acetate vial. The study was performed in the Department of Oral and Maxillofacial Surgery, Ghazi Alhareery Hospital—Medical City, from October 2017 to September 2018. After 4 months of clinical follow-up, the results revealed that the GCS injection has minimal outcomes in the treatment of TMJ internal derangement compared to arthrocentesis. On the other hand, arthrocentesis and lavage had dedicated promising outcomes.

Objective: To assess the cervical spine derangement among working dentists using MRI in order to establish a relationship between job parameters and cervical derangement changes. Methods: A cross-sectional study was carried out at the MRI unit of Al-Sader Medical city of Al Najaf health directorate from June 2015 to December 2016. The involved 43 working dentist volunteers of varying age and sex, who underwent an MRI of their cervical spine. Results: The MRI was normal in 16 (37.3%) and abnormal in 27 (62.8%) participants. The abnormality was due to cervical spine spondylitis changes. Conclusion: Intervertebral Discs (IVD) degeneration was the most frequent finding, followed by IVD herniation.

BackgroundTo investigate differences in the tibial tubercle-trochlear groove (TT-TG) and patellar tendon-posterior cruciate ligament (PT-PCL) distances in symptomatic patients with non-contact internal knee derangements (IKD) and symptomatic patients with internally intact knees (control).MethodsA retrospective review of MRI studies was completed by comparing 78 patients with meniscal and ligamentous derangements of the knee to 63 internally intact knees (age range, 13 to 50 years). MRI findings were reviewed independently by two board-certified radiologists to assess for agreement. TT-TG and PT-PCL distances were measured on proton density-weighted axial images by two independent observers blinded to the MRI and arthroscopic findings. Independentttests were used to determine differences in TT-TG distance between the internal derangement and control groups. Chi-square tests were used to compare categorical variables for distributional equality between study groups.ResultsThe mean TT-TG distance averaged across the two raters in the IKD group was 11.5 mm (95% confidence interval [CI], 10.6–12.4), compared to 8.3 mm (95% CI, 7.6–9.0) in the control group (p< 0.001). The mean PT-PCL distance similarly averaged across both raters was 20.6 mm (95% CI, 19.7–21.5) for the IKD group compared to 18.2 mm (95% CI, 17.2–19.2) for the control group (p< 0.001). Among the IKD group, there were 51 meniscal tears, 12 cruciate ligament tears, and 15 tears with a combination of meniscal and cruciate findings. IKD was significantly correlated with greater TT-TG distance (p< 0.001) and greater PT-PCL distance (p< 0.003) when compared with control.ConclusionsIncreased TT-TG distances and PT-PCL distances are associated with both cartilaginous and ligamentous internal knee injuries in the present study, with TT-TG distances greater than the 12 mm representing a new threshold for concern.

BACKGROUND Frailty is associated with increased morbidity and mortality and frail patients may have reduced ability to tolerate severe vital sign derangement such as estimated by a high National Early Warning Score (NEWS). The clinical impact of frailty among patients that develop high NEWS during hospital admissions is sparsely studied. The aim of this study was to investigate the association between clinical frailty and admission to intensive care unit (ICU) among these patients. METHODS We conducted a prospective observational study from November 2017 to January 2018. We included adult patients admitted to general wards that during hospitalization developed severe vital sign derangement defined as NEWS ≥7. Patients were without treatment restrictions at inclusion. Primary exposure was frailty as assessed by the Clinical Frailty Scale. Primary outcome was ICU admission within 90 days, which was analyzed using multivariate logistic regression. RESULTS We included 109 patients with NEWS ≥7, of which 61 patients (56%) were frail. Ten of the 61 frail patients (16%) were admitted to ICU compared to 9 of the 48 non-frail patients (19%), adjusted odds ratio (aOR) 0.92 (95% CI 0.32-2.62). Frail patients were more likely to have new treatment restrictions (aOR 2.91; 95% CI 1.26-6.71). Their aOR for mortality was 1.95 (95% CI 0.84-4.55). CONCLUSION Frail patients with severe vital sign derangement during acute hospital admissions were not more likely to be admitted to ICU nor was mortality higher. Treatment restrictions were more frequent among frail patients after vital sign derangements developed.

The objective was to describe the prevalence of derangement of the partial pressure of arterial carbon dioxide (PaCO2) and to determine the association between PaCO2 and adverse cardiovascular events (ACVEs) in carbon monoxide (CO)-poisoned patients. Additionally, we evaluated whether the derangement of PaCO2 was simply secondary to metabolic changes. This retrospective study included 194 self-breathing patients after CO poisoning with an indication for hyperbaric oxygen therapy and available arterial blood gas analysis at presentation and 6 h later. The incidence rate of hypocapnia at presentation after acute CO poisoning was 67.5%, and the mean PaCO2 during the first 6 h was 33 (31–36.7) mmHg. The most common acid–base imbalance in 131 patients with hypocapnia was primary respiratory alkalosis. The incidence rate of ACVEs during hospitalization was 50.5%. A significant linear trend in the incidence of ACVEs was observed across the total range of PaCO2 variables. In multivariate regression analysis, mean PaCO2 was independently associated with ACVEs (odds ratio 0.051; 95% confidence interval 0.004–0.632). PaCO2 derangements were common after acute CO poisoning and were not explainable as a mere secondary response to metabolic changes. The mean PaCO2 during the first 6 h was associated with ACVEs. Given the high incidence of ACVEs and PaCO2 derangement and the observed association between the mean PaCO2 and ACVEs, this study suggests that (1) PaCO2 should be monitored in the acute stage to predict and/or prevent ACVEs and (2) further investigation is needed to validate this result and explore the early manipulation of PaCO2 as a treatment strategy.

This prospective clinical study aimed to establish a new classification system for TMJ internal derangement based on MRI in correlation with clinical findings contributing to a nonsurgical treatment protocol. A consecutive sample of 435 internal derangement patients was enrolled in the study. Clinical and MRI studies were used to establish the new classification system. A total of 747 joints were classified according to our staging system and received treatment according to the associated nonsurgical treatment protocol. The primary outcome variables were maximum voluntary mouth opening and visual analogue scale pain scores. The secondary outcome variable was joint sound. Statistical analysis of the differences between pretreatment and posttreatment measurements showed an increase in mouth opening throughout the study period (P VAS scores showed a statistically significant decrease in all study groups during all study periods, with P joint sounds showed significant improvement during all study periods. The new classification system is a simple, & reasonable including a detailed description of all the pathologic changes of the joint. The nonsurgical treatment protocol was Simple, effective and specific depending on the pathological changes in joint.

Background Rapid response systems aim to achieve a timely response to the deteriorating patient; however, the existing literature varies on whether timing of escalation directly affects patient outcomes. Prior studies have been limited to using ‘decision to admit’ to critical care, or arrival in the emergency department as ‘time zero’, rather than the onset of physiological deterioration. The aim of this study is to establish if duration of abnormal physiology prior to critical care admission [‘Score to Door’ (STD) time] impacts on patient outcomes. Methods A retrospective cross-sectional analysis of data from pooled electronic medical records from a multi-site academic hospital was performed. All unplanned adult admissions to critical care from the ward with persistent physiological derangement [defined as sustained high National Early Warning Score (NEWS) > / = 7 that did not decrease below 5] were eligible for inclusion. The primary outcome was critical care mortality. Secondary outcomes were length of critical care admission and hospital mortality. The impact of STD time was adjusted for patient factors (demographics, sickness severity, frailty, and co-morbidity) and logistic factors (timing of high NEWS, and out of hours status) utilising logistic and linear regression models. Results Six hundred and thirty-two patients were included over the 4-year study period, 16.3% died in critical care. STD time demonstrated a small but significant association with critical care mortality [adjusted odds ratio of 1.02 (95% CI 1.0–1.04, p = 0.01)]. It was also associated with hospital mortality (adjusted OR 1.02, 95% CI 1.0–1.04, p = 0.026), and critical care length of stay. Each hour from onset of physiological derangement increased critical care length of stay by 1.2%. STD time was influenced by the initial NEWS, but not by logistic factors such as out-of-hours status, or pre-existing patient factors such as co-morbidity or frailty. Conclusion In a strictly defined population of high NEWS patients, the time from onset of sustained physiological derangement to critical care admission was associated with increased critical care and hospital mortality. If corroborated in further studies, this cohort definition could be utilised alongside the ‘Score to Door’ concept as a clinical indicator within rapid response systems.

Respiratory failure is typically associated with changes in pCO2leading to respiratory alkalosis (type 1 failure) and respiratory acidosis (type 2). As a compensatory response, plasma HCO3concentration decreases if pCO2decreases and increases conversely. These secondary responses prevent large pH fluctuations. However, metabolic acid-base disorders may still occur as a consequence of dysfunction of other organs and/or medical treatments. To recognize superimposed acid-base disorders, the availability of an accurate prediction of the expected HCO3that corresponds to a given pCO2is crucial. In chronic hypocapnia, the compensatory metabolic response is regulated by the equation ΔHCO3/ΔpCO2=0.4 mEq/L per mm Hg. An easy rule to compute the expected value of HCO3may be 0.4×pCO2+9. In chronic hypercapnia, the equation is ΔHCO3/ΔpCO2=0.48 mEq/L per mm Hg, and the expected value of HCO3becomes 0.48×pCO2+4.74. While this expression is accurate, it seems to be of limited use for simple "bedside" predictions. In this contribution, we propose the simpler expression: the expected value of HCO3in chronic hypercapnia=½ pCO2+3.5. For values of pCO2not exceeding 70 mm Hg, with the proposed expression, the difference in HCO3prediction in respect to the previous one is

BACKGROUND: Classification of spinal pain has been a key goal identified in the research. However it is not clear if existing classification systems are comprehensive. OBJECTIVE: To examine the comprehensiveness and distribution of classifications within the McKenzie classification system (MDT), and the directional preference in consecutive patients with spine pain. STUDY DESIGN: Prospective, observational study. METHODS: Clinicians with a Diploma in MDT provided data on patients that they had assessed, classified, managed, and then confirmed their classification at discharge. They provided data on the spinal area, the MDT classification, and the loading strategy used in management. RESULTS: Fifty-four clinicians from at least 15 different countries provided data on 750 patients: lumbar 64.8%, cervical 29.6%, thoracic 5.6%. The distribution of classifications was as follows: Derangement 75.4%, OTHER 22.8%, Dysfunction 1.7%, Postural syndrome 0.1%. In Derangements 82.5% had a directional preference for extension, 12.9% for lateral forces, and 4.6% for flexion. Those patients classified as one of the OTHER subgroups were given specific classifications. CONCLUSION: Derangement was the most common classification and extension was by far the most common directional preference. A substantial proportion were classified as OTHER subgroups, for whom management is less straightforward.

Temporomandibular joint disorders are a common cause of chronic musculoskeletal pain worldwide. Among these, internal disc derangement is the most frequent type of disorder. Internal derangement is defined as an abnormal positional and functional relationship between the disc and articulating surfaces. Common clinical symptoms include pain and clicking. Imaging plays a key role in diagnosing temporomandibular joint disorders. It is important for the radiologist to detect early imaging signs of internal derangement, thereby avoiding the evolution of this condition to degenerative joint disease. The aim of this article is to familiarise the reader with the spectrum of imaging findings that are encountered at different stages of the disease.

WOS: 000452890300002, PubMed: 30541231, Background/aim: Temporomandibular joint (TMJ) internal derangements consist of reduced and nonreduecd disc dislocations and are often diagnosed by magnetic resonance imaging (MRI). The main symptom of these derangements is TMJ pain. This study aimed to evaluate whether there is a correlation between TMJ pain and disc dislocation. Materials and methods: One hundred and four patients experiencing pain were evaluated retrospectively with the examination charts that we use routinely in our clinics and MRI. Patients were separated into two main groups as MRI(+) and MRI(-) groups according to their internal derangement findings in MRI. Mean VAS levels were compared between these two groups. Results: There were no significant differences between the MRI(+) and MRI(-) groups and no differences between the reduced disc dislocation group and nonreduced disc dislocation group. Conclusion: Although pain is maybe the most irritating symptom for TMJ patients, it cannot take the diagnostic place of MRI and MRI is still the gold standard method to make the exact diagnose of internal derangement.

… Objectives: Tuberculosis (TB) is a major cause of illness and death worldwide,especially in Asia and Africa. An effective control has been achieved by the widespread use ofATT. It has been postulated that hepatotoxicity induced by ATT is not truly idiosyncratic inessence; rather certain genetic and environmental factors are attributed to coincide to producesufficient quantity of toxic metabolites that then cause varied alterations in liver functions.Objective of the study was to determine the frequency of derangement of liver enzymes inpatients taking anti-tuberculous therapy within the first 8 weeks of therapy. Study Design: Adescriptive case series study. Place and Duration of Study: The study was conducted at the inpatientand out-patient department of general medicine of Pakistan Institute of Medical Sciences(PIMS), Islamabad for blood sampling and biochemical assays. Material and Methods: Thestudy was performed on a total of 114 patients of tuberculosis. ATT was started after baseline liverfunction tests. Liver function tests were repeated at 4 weeks and 8 weeks to observe the effects onliver enzymes derangement. Results: 12 patients had deranged LFTs while 102 patients hadnormal LFTs after 4 weeks of treatment while 10 patients had deranged LFTs and 104 patients hadnormal LFTs after 8 weeks of treatment. Conclusions: Anti-tuberculosis drugs inducedhepatotoxicity occurs less frequently. All patients put on anti-tuberculous therapy must befollowed up for at least the initial 4 weeks, and the patient and caregivers should be told how torecognize signs of anti-tuberculous induced hepato-toxicity.

background: Temporomandibular joint (TMJ) problems frequently characterized via pain and impairment of joint function and clicking sounds. TMJ internal derangement (ID) is the main widespread kind of temporomandibular disorders (TMDs), as 41.1% of suffers from TMD. Almost twenty-five percent of the population has an ID. TMJ ID's treatment regimens can be categorized into two subgroups: conservative and surgical. Early degrees of ID may be treated with medical or minimally invasive techniques according to Wilkes classification; however, the more advanced degrees (IV or V) may need open joint surgery. Aim of the work: assess the effectiveness of anterior temporal eminectomy in management of the manifestation of the ID of the TMJ disorder. Method: From Nov 2019 to Nov 2020. includes 10 patients with ID of the TMJ, presented to Plastic Surgery outpatient clinic, Damietta Al-Azhar University Hospital. Results: We include 10 patients 3 males, 7 females with a mean age of 32.70 ± 8.69 years. pain was presented in 5 patients, improved in 4 patients postoperatively. Clicking was present pre-operatively in 7 cases,which resolved in 5 patients after surgery. Conclusion: Anterior eminectomy, is a technique recommended for the management of ID. It enables the non-reducible disk to be a reducible disk, prevents pain inside of the TMJ, and promotes the flexible movement of TMJ. It's a safe, successful surgical technique that playing a role in the treatment as a 2nd-line surgical option in the treatment of ID of TMJ after other conservative medical options have fail

Introduction Arthroscopic treatment of the temporomandibular joint (TMJ) has traditionally been evaluated with clinical measurements. Additional recordings of patient reported outcome measures (PROM) is expected to make the evaluation more complete. The aim of the study was to evaluate if PROM correlates with clinical follow-up measures after arthroscopic treatment of internal derangement of the TMJ. Material and methods Patients with temporomandibular dysfunction (TMD), treated with arthroscopic lysis and lavage of the TMJ, were followed with a PROM questionnaire; Jaw Functional Limitation Scale 20 (JFLS-20) and a review of patient medical records. Out of 239 patients treated, 134 were eligible for inclusion to the study. Results 91 subjects, 21 males and 70 females, with mean age 42.6 years completed the follow-up. The JFLS-20 mean score was 25.43 (range: 0–148). A correlation was found between JFLS and mouth opening. The JFLS-20 score was decreased by 1.48 (p = 0.0001) for ever millimeter larger mouth opening and with 1.16 (p = 0.001) for every gained millimeter of mouth opening after arthroscopic treatment of the TMJ. The mean maximal mouth opening was 38.43 mm preoperatively (15 to 75 mm) compared to 42.19 mm postoperatively (range: 21–75 mm). A total of 80 subjects with TMD associated pain preoperatively was reduced to 25 postoperatively (p = 0.0001). Discussion Advantageous treatment effect with arthroscopic lysis and lavage was presented. The outcome of the JFLS-20 questionnaire indicates a correlation with the clinical findings. Future studies will focus on larger cohorts and using PROM with a case-control setting.

~10% of dementia patients have idiopathic normal pressure hydrocephalus (iNPH), an expansion of the cerebrospinal fluid (CSF)-filled brain ventricles. iNPH and Alzheimer’s disease (AD) both exhibit sleep disturbances, build-up of brain metabolic wastes and Aβ plaques, perivascular reactive astrogliosis, and mislocalization of astrocyte Aquaporin-4 (AQP4). The glymphatic system facilitates brain fluid clearance and waste removal during sleep via glia-supported perivascular channels. Human studies have implicated impaired glymphatic function in both AD and iNPH. Continued investigation into the role of glymphatic system biology in AD and iNPH models could lead to new strategies to improve brain health by restoring homeostatic brain metabolism and CSF dynamics.

Background MRI is currently gold standard non-invasive diagnostic imaging modality of choice for nearly all clinical indications concerning the knee. MRI provides excellent visualization of the internal structures of the knee along with soft tissue structures and bone marrow abnormalities (1). Aim of the work determine diagnostic role of MRI in studying types of internal knee derangements of the traumatic knee. Patients and Methods A cross sectional study of thirty four patient of knee joint trauma who underwent MRI for internal derangement of knee at Radio-diagnosis department of Ain Shams University Hospitals in the period from October 2017 to march 2018. Results commonest lesion detected in our study was ACL tear detected in 24 patients.16 patients of with partial ACL tear and 8 patients with complete ACL tear, followed by knee joint effusion medial meniscus tear. Lateral meniscal injuries were less common when compared to medial meniscalinjuries. Conclusion MR imaging is the best non-invasive imaging modality for diagnosis of types of internal derangement of knee joint as it provides excellent visualization of the internal structures of the knee, soft tissue structures and, bone marrow abnormalities. Recommendation further studies with much more population and correlation with arthroscopy for more accurate results.

Purpose The aim of this report is to define a modification of the arthroscopic anterior myotomy that avoids disc suturing procedures for the treatment of advanced internal derangement (I D) of the temporomandibular joint (TMJ). Surgical technique The minimally invasive arthroscopic anterior myotomy (MIAAM) is based on a partial resection of the superior belly of the lateral pterygoid muscle performed through a small incision of the articular capsule associated with a scarification of the posterior ligament of the TMJ. The high-frequency wave system, called Coblation, is extremely useful to be able to complete the MIAAM. Conclusion This technique is indicated for patients with ID and Wilkes stages III–IV without response to conservative treatments, and the presence of an integral disc with an appropriate consistency is transcendent for the success of the procedure. Because of the unique characteristics of the MIAAM, it can be considered as an alternative to arthroscopic discopexy procedures.

Single-sheet, cheap-to-print publications popularized in urban centres in the seventeenth and eighteenth centuries, broadsides were used to disseminate knowledge and entertainment among the common reading classes of England. Murder broadsides were a particularly common genre during the Victorian period in the mid-to-late-nineteenth century, and while the majority of these focused on the downfalls of male criminals, a significant number of publications concerning female murderers survives. Studying how broadsides were produced, read, and shared, especially in London, this paper examines the significance of their representations of female murderers. Ultimately, murder broadsides about women embodied the anxieties of the Victorian age. In the city, social boundaries were pushed, crossed, and blurred relentlessly; broadsides and their representations of women were active expressions of and responses to such anxieties. But while the tendency of broadsides was towards “moral conservativism” which sought to condemn violent crime, promote sexual purity, and sanctify chaste mothers and wives, broadsides also afforded the women they portrayed a certain notoriety and voice, complicating the common reading of the broadside as a prescriptive or even repressive document.

Purpose. To present an advanced ultrasound (US) technique and propose its use as a screening diagnostic tool for temporomandibular joint (TMJ) internal derangement. Materials and Methods. The technique is based on maintaining the US probe parallel to the articular disc, rather than traditional axial and coronal views, with the position described relative to a clock face. Validation was achieved by direct comparison with magnetic resonance imaging (MRI). A total of 61 patients, with age ranging from 13 to 67 years, were prescreened for TMJ pain and internal derangement, underwent US imaging for screening, and MRI evaluation for final diagnosis. Results. 29 of the 61 patients had disc pathology on MRI. US screening produced no false positive results and only 6 false negative results, corresponding to a sensitivity of 79% and specificity of 100%. Half of the false negative cases involved disc pathology with a medial component to the disc displacement. Conclusion. US is both a sensitive and a specific screening tool for TMJ dysfunction when used by an appropriately trained operator, with the exception of medially displaced discs. If TMJ assessment is found to be abnormal, the patient should be referred for MRI, and any patient scheduled for surgery must have the diagnosis confirmed by MRI. If a component of medial disc displacement is suspected, MRI should be performed despite a normal screening US.

Background: Mechanical diagnosis and therapy (MDT) is a specific classification-based musculoskeletal examination and intervention system that uses repeated end range and sustained movement to classify patients into mechanical syndromes. Research has recently demonstrated increased prevalence, reliability, and efficacy of MDT syndromes in varied peripheral musculoskeletal populations. There is currently no research analyzing if predictive variables exist for establishing directional preference in peripheral joints, other than the wrist. The aim of this study was to examine the clinical application of predictive variables for establishing directional preference and spinal referral in patients with isolated peripheral joint pain. Case Description: Thirty-seven consecutive patients with isolated peripheral pain were evaluated and classified using MDT assessment. Secondary analysis of predetermined variables was performed for association with directional preference and identification of spinal referral in Derangement syndrome. Results: All 37 patients were classified using MDT assessment. Thirty-three (89.2%) were classified as Derangement syndrome: 17 as spinal Derangement (45.9%) and 16 as peripheral Derangement (43.2%). One peripheral derangement also had an underlying Articular Dysfunction. Additionally, there were four patients classified as Other (10.8%). Discussion: Historical and physical examination findings were analyzed to determine if there were associated variables of directional preference or spinal referral. Mechanical stress was found to be the most associated factor in predicting directional preference. No peripheral movement loss, paresthesia, and constant pain were more associated with spinal referral. These findings may lead to a greater understanding of peripheral MDT assessment, which may lead to increased identification of directional preference and improved patient outcomes. Level of Evidence: 4.

Introduction: Severe hypoxic ischemic organ damage is caused by asphyxia innewborns which can follow fatal outcomes or severe life-long pathologies like renal insufficiency.We wanted to note the frequency of renal derangement in neonates having asphyxia neonatoumin this study. Setting & Period: Department of Pediatrics, Bahawal Victoria Hospital (BVH),Bahawalpur, from 1st January 2017 to 31st June 2017. Materials & Methods: Two hundredand sixty four neonates of both genders with birth asphyxia were included in the study. Mainoutcome was renal derangement in asphyxia neonatorum. Results: Mean weight was 2.54kg with standard deviation 0.50 kg and having mean APGAR score 4.43 with SD 1.66. 0It wasnoted that 189 (71.6%) neonates had Renal derangement in which 109 (57.7%) were males and80 (42.3%) were females with mean of weight was 2.53kg, having mean APGAR score 4.44.Conclusion: Renal derangement is quite common in neonates with birth asphyxia.

Anterior disc displacement with or without reduction is a common finding in symptomatic and asymptomatic individuals. When symptomatic and associated with dysfunction it requires an intervention. Once nonsurgical management fails and the patient does not respond to minimally invasive procedures, open surgical treatment is indicated. However, controversy exists about whether disc-preservation procedures, such as repositioning/repairing or disc removal, is the preferred treatment. This article evaluates the current evidence supporting both treatment options and highlights the indications, contraindications, and consequences of each.

Background Temporomandibular dysfunction involving anterior disc derangement with or without reduction, secondary to posterior ligament insufficiency is typically managed conservatively with success in a majority of patients. When conservative management fails, the next step in the continuum of care is unclear. Platelet-rich plasma injection combined with a 3-week immobilization period may be effective in treating posterior ligament insufficiency following a period of physical therapy. The result of this case was exceptionally successful, with the patient reporting 100% improvement 6 months post-injection. Prior to this case, we predicted a 20% success rate based on her inability to maintain the effects of conservative management over the long term. Case presentation A 33-year-old white woman presented with temporomandibular dysfunction, which responded to an initial course of physical therapy aimed at restoring the mechanics of her temporomandibular joint, exercise management, and education on self-management strategies. She returned 20 months later and responded well to another course of physical therapy. Despite improvement in pain, range of motion, and mechanics, she continued to present with a reduction click at the end range of opening. The crisp and loud nature of the reduction click indicated a viable posterior ligament and reduction of the anteriorly displaced disc. She opted for platelet-rich plasma injection, provided by a chronic pain specialist with the assistance of a physical therapist. She was immobilized for 3 weeks, followed by a weaning period with reduced posterior support for an additional 5 weeks. Follow-up appointments with a physical therapist occurred at 3 weeks, 8 weeks, and 6 months post-injection. Conclusions At 6 months, she reported 100% improvement. Objectively, there was no indication that the disc condyle relationship was disrupted. At 6 months post-platelet-rich plasma injection, preceded by a period of conservative physical therapy management, and followed with appropriate physical therapy follow-up, this individual had complete resolution of her anterior disc derangement with reduction. Electronic supplementary material The online version of this article (10.1186/s13256-018-1637-8) contains supplementary material, which is available to authorized users.